Healthcare Provider Details

I. General information

NPI: 1750503348
Provider Name (Legal Business Name): HUMBOLDT SENIOR RESOURCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 NEWBURG ROAD
FORTUNA CA
95540-2511
US

IV. Provider business mailing address

1910 CALIFORNIA ST
EUREKA CA
95501-2870
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-9747
  • Fax: 707-443-3498
Mailing address:
  • Phone: 707-725-6927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADU70071F
License Number StateCA

VIII. Authorized Official

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