Healthcare Provider Details

I. General information

NPI: 1235722026
Provider Name (Legal Business Name): THE CERES COMMUNITY PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7351 BODEGA AVE
SEBASTOPOL CA
95472-3727
US

IV. Provider business mailing address

PO BOX 1562
SEBASTOPOL CA
95473-1562
US

V. Phone/Fax

Practice location:
  • Phone: 707-829-5833
  • Fax: 707-324-3828
Mailing address:
  • Phone: 707-829-5833
  • Fax: 707-324-3828

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 Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: MS. CATHRYN ELIZABETH COUCH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MBA
Phone: 707-829-5833