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General NPI Number Information
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NPI Number | 1760668891
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Entity Type | Organization
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Legal Business Name | ALDA GOINES
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 2962 JEFFERSON AVE
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City | YUBA CITY
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State | CA
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Zip | 95993-8824
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Country | US
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Telephone | 530-674-1129
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Fax | 530-674-1506
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Provider Business Mailing Address
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Address Line | 2962 JEFFERSON AVE
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City | YUBA CITY
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State | CA
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Zip | 95993-8824
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Country | US
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Telephone | 530-674-1129
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Fax | 530-674-1506
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Authorized Official
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Title or Position | ADMINISTRTOR
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Name | MS. AIDA D GOINES
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Credential |
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Telephone | 530-674-1129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number | 515002059
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | 515002059
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 515002059
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License Number State | CA
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