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General NPI Number Information
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NPI Number | 1083689848
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Entity Type | Organization
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Legal Business Name | HUMANGOOD SOCAL
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 1763 ROYAL OAKS DR
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City | DUARTE
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State | CA
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Zip | 91010-1970
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Country | US
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Telephone | 626-359-9371
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Fax | 626-358-6588
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Provider Business Mailing Address
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Address Line | 1900 HUNTINGTON DR
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City | DUARTE
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State | CA
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Zip | 91010-2694
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Country | US
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Telephone | 818-247-0420
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Fax | 949-528-2434
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Authorized Official
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Title or Position | DIRECTOR OF ACCOUNTS RECEIVABLE
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Name | GWEN ELLEN VANGELISTO
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Credential |
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Telephone | 949-463-0893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 950000121
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License Number State | CA
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