MEDICARE: HOUSING EL DORADO

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	251X00000X	Supports Brokerage Agency

General Provider Information

NPI Number	:	1891510475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSING EL DORADO

Provider Business Mailing Address
First Line	:	1390 BROADWAY # B-216
Second Line	:
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-5900
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1390 BROADWAY # B-216
Second Line	:
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-5900
Country	:	US
Telephone Number	:	530-317-8877
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM COORDINATOR
Name	:	NICHOLE PAINE
Credential	:
Telephone Number	:	530-317-8877

Provider Enumeration Date	:	11/19/2024
Last Update Date	:	11/19/2024

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Directions to “HOUSING EL DORADO ” Practice Location

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