NPI 1063791713

Gardenside Eldercare, LLC

Organisation Physical Disabilities Residential Treatment Facility Fortuna, CA

Practice location

Address: 529 9th Street, Fortuna, CA 95540
Phone: (707) 725-7873
Fax: (707) 215-7036
Mailing address: 1095 S Fortuna Blvd STE F, Fortuna, CA 95540-3067

Authorised official

Name: Trina Keller
Title: Member
Phone: (707) 725-7873

Registered specialties

Physical Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320700000X Licence 126802046 (CA)

Other Residential Treatment Facility, Physical Disabilities providers in California →

Registry record

NPI: 1063791713
Entity type: Organization
NPI issued: 12 Aug 2011
Record last updated: 12 Aug 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.