Healthcare Provider Details

I. General information

NPI: 1538749338
Provider Name (Legal Business Name): FOOD FOR THOUGHT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 RAILROAD AVE
FORESTVILLE CA
95436-9477
US

IV. Provider business mailing address

PO BOX 1608
FORESTVILLE CA
95436-1608
US

V. Phone/Fax

Practice location:
  • Phone: 707-887-1647
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: KAREN GARDNER
Title or Position: GRANTS AND SPECIAL PROJECTS MANAGER
Credential:
Phone: 707-887-1647