Provider Demographics
NPI:1053782623
Name:CONSONUS HEALTHCARE
Entity type:Organization
Organization Name:CONSONUS HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:ASSOCIATES DEGREE
Authorized Official - Phone:707-228-3085
Mailing Address - Street 1:2053 COOPER DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-5683
Mailing Address - Country:US
Mailing Address - Phone:707-228-3085
Mailing Address - Fax:
Practice Address - Street 1:684 BENICIA DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-3058
Practice Address - Country:US
Practice Address - Phone:707-538-0152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA1007320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOTA 1007OtherCA BOARD OF OCCUPATIONAL THERAPY