Healthcare Provider Details

I. General information

NPI: 1871428987
Provider Name (Legal Business Name): INDEPENDENT HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 ESPLANADE WAY
YUBA CITY CA
95993-1010
US

IV. Provider business mailing address

1615 ESPLANADE WAY
YUBA CITY CA
95993-1010
US

V. Phone/Fax

Practice location:
  • Phone: 530-674-1129
  • Fax: 530-674-1129
Mailing address:
  • Phone: 530-674-1129
  • Fax: 530-674-1129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name: AIDA DIAZ GOINES
Title or Position: MANAGER
Credential: HOME
Phone: 530-635-7585