Healthcare Provider Details

I. General information

NPI: 1326100504
Provider Name (Legal Business Name): UKIAH SENIOR CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

497 LESLIE ST
UKIAH CA
95482-5506
US

IV. Provider business mailing address

497 LESLIE ST
UKIAH CA
95482-5506
US

V. Phone/Fax

Practice location:
  • Phone: 707-462-4343
  • Fax: 707-462-2997
Mailing address:
  • Phone: 707-462-4343
  • Fax: 707-462-2997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADU70096F
License Number StateCA

VIII. Authorized Official

Name: MS. BRENDA CHRISTIAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 707-462-4343