NPIMap

Organization Active NPI

Humboldt Senior Resource Center

Doing business as Fortuna Adult Day Health Care

  • Adult Day Care Clinic/Center
  • Fortuna, CA
National Provider Identifier
1750503348
Registry record updated May 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Day Care Clinic/CenterTaxonomy code 261QA0600X
License
ADU70071F Issued in CA
Legal business name
HUMBOLDT SENIOR RESOURCE CENTER
Doing business as
Fortuna Adult Day Health Care
Practice address
3200 Newburg Road
Fortuna, CA 95540-2511
Phone
(707) 443-9747
Fax
(707) 443-3498
NPI assigned
May 3, 2007
Last updated
May 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Melissa Hooven
Title
Chief Executive Officer
Phone
(707) 443-9747

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Day Care Clinic/Center 261QA0600X ADU70071F CA Primary

Addresses

Primary practice location

3200 Newburg Road
Fortuna, CA 95540-2511

Mailing address

1910 California St
Eureka, CA 95501-2870
Phone (707) 725-6927

Other identifiers 1

IdentifierTypeStateIssuer
ADU70071FMedicaidCA

Other names 1

  • Fortuna Adult Day Health Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Humboldt Senior Resource Center4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2280 Newburg Rd
Fortuna, CA 95540

3200 Newburg Rd
Fortuna, CA 95540
Phone (707) 443-9747

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590105600000",
    "number": "1750503348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 CALIFORNIA ST",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955012870",
            "telephone_number": "707-725-6927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 NEWBURG ROAD",
            "city": "FORTUNA",
            "state": "CA",
            "postal_code": "955402511",
            "telephone_number": "707-443-9747",
            "fax_number": "707-443-3498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUMBOLDT SENIOR RESOURCE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2020-05-22",
        "certification_date": "2020-05-22",
        "status": "A",
        "authorized_official_last_name": "HOOVEN",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "707-443-9747"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "CA",
            "license": "ADU70071F",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ADU70071F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fortuna Adult Day Health Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fortuna Adult Day Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fortuna, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.