Healthcare Provider Details

I. General information

NPI: 1942082458
Provider Name (Legal Business Name): HOMELESS GARDEN PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 10/18/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W CLIFF DR
SANTA CRUZ CA
95060-5419
US

IV. Provider business mailing address

PO BOX 617
SANTA CRUZ CA
95061-0617
US

V. Phone/Fax

Practice location:
  • Phone: 831-426-3609
  • Fax:
Mailing address:
  • Phone: 831-426-3609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: DARRIE GANZHORN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 831-426-3609