MEDICARE: COMMON GOALS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336490069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMON GOALS, INC.

Provider Business Mailing Address
First Line	:	256 BUENA VISTA ST
Second Line	:	SUITE 100
City	:	GRASS VALLEY
State	:	CA
Zip	:	95945-7239
Country	:	US
Telephone Number	:	530-274-2000
Fax Number	:	530-274-2116

Provider Business Practice Location Address
First Line	:	256 BUENA VISTA ST
Second Line	:	SUITE 100
City	:	GRASS VALLEY
State	:	CA
Zip	:	95945-7239
Country	:	US
Telephone Number	:	530-274-2000
Fax Number	:	530-274-2116

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JOSEPH J FESTERSEN
Credential	:
Telephone Number	:	530-265-2914

Provider Enumeration Date	:	09/20/2012
Last Update Date	:	06/16/2015

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