Healthcare Provider Details

I. General information

NPI: 1164644746
Provider Name (Legal Business Name): HUMBOLDT SENIOR RESOURCE CENTER, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 CALIFORNIA ST.
EUREKA CA
95501
US

IV. Provider business mailing address

1910 CALIFORNIA ST.
EUREKA CA
95501
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-9747
  • Fax: 707-443-3498
Mailing address:
  • Phone: 707-443-9747
  • Fax: 707-443-3498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADU70031F
License Number StateCA

VIII. Authorized Official

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