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General NPI Number Information
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NPI Number | 1326100504
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Entity Type | Organization
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Legal Business Name | UKIAH SENIOR CENTER
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 497 LESLIE ST
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City | UKIAH
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State | CA
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Zip | 95482-5506
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Country | US
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Telephone | 707-462-4343
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Fax | 707-462-2997
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Provider Business Mailing Address
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Address Line | 497 LESLIE ST
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City | UKIAH
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State | CA
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Zip | 95482-5506
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Country | US
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Telephone | 707-462-4343
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Fax | 707-462-2997
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. BRENDA CHRISTIAN
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Credential |
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Telephone | 707-462-4343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | ADU70096F
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License Number State | CA
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