Healthcare Provider Details

I. General information

NPI: 1356599278
Provider Name (Legal Business Name): HUMBOLDT SENIOR RESOURCE CENTER INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 H ST
EUREKA CA
95501-1026
US

IV. Provider business mailing address

1910 CALIFORNIA ST
EUREKA CA
95501-2870
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-9747
  • Fax: 707-443-7277
Mailing address:
  • Phone: 707-443-9747
  • Fax: 707-443-7277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA HOOVEN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 707-443-9747