Healthcare Provider Details

I. General information

NPI: 1366109704
Provider Name (Legal Business Name): THE GATHERING INN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 07/30/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BERKELEY AVE
ROSEVILLE CA
95678-2205
US

IV. Provider business mailing address

201 BERKELEY AVE
ROSEVILLE CA
95678-2205
US

V. Phone/Fax

Practice location:
  • Phone: 916-791-9355
  • Fax: 916-791-1916
Mailing address:
  • Phone: 916-791-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. ROLANDE TELLIER
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 916-791-9355