Gardenside Eldercare, LLC
Organization Active NPI Physical Disabilities Residential Treatment Facility · Fortuna, CA
NPI 1063791713 · NPPES record last updated Aug 12, 2011
Key facts
- NPI
- 1063791713
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Disabilities Residential Treatment Facility 320700000X
- License
- 126802046 (CA)
- Legal business name
- GARDENSIDE ELDERCARE, LLC
- Practice address
- 529 9TH Street
Fortuna, CA 95540 - Phone
- (707) 725-7873
- Fax
- (707) 215-7036
- NPI assigned
- Aug 12, 2011
- Organization subpart
- No
Authorized official
- Name
- Mrs. Trina Keller
- Title
- Member
- Phone
- (707) 725-7873
National Provider Directory
Locations
1095 S Fortuna Blvd
Ste F
Fortuna, CA 95540
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Disabilities Residential Treatment Facility | 320700000X | 126802046 | CA | Yes |
Addresses
Primary practice location
529 9TH Street
Fortuna, CA 95540
Mailing address
1095 S Fortuna Blvd Ste F
Fortuna, CA 95540-3067
Phone (707) 725-7873
Other providers in Fortuna, CA
- Donald Vincent Fregeau Jr.
- Alan E French
- William M French
- Janna M Froeming
- Judy Gallagher
- Gina Rose Gastelum
- Melanie Ror-Ree Gensaw
- Joyme Balan Gesite
- Chris Ghadimi
- Lexis D Gillette
All providers in Fortuna, CA · Physical Disabilities Residential Treatment Facility in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 12, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.