Healthcare Provider Details

I. General information

NPI: 1710691514
Provider Name (Legal Business Name): HARVEST HOUSE TRANSITIONAL RESIDENCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 CANDY DR
VALLEJO CA
94589-1403
US

IV. Provider business mailing address

PO BOX 9063
VALLEJO CA
94591-9063
US

V. Phone/Fax

Practice location:
  • Phone: 707-888-4058
  • Fax:
Mailing address:
  • Phone: 707-888-4058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: TRENNY MCCOLLUMN
Title or Position: CEO
Credential:
Phone: 800-577-7358