MEDICARE: HUMANGOOD SOCAL

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	314000000X	Skilled Nursing Facility	970000052	CA

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	:	1972588846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUMANGOOD SOCAL

Provider Business Mailing Address
First Line	:	516 BURCHETT STREET
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-1014
Country	:	US
Telephone Number	:	818-247-0420
Fax Number	:	818-247-3871

Provider Business Practice Location Address
First Line	:	1230 E. WINDSOR RD.
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205
Country	:	US
Telephone Number	:	818-244-7219
Fax Number	:	818-240-3887

Authorized Official
Title or Position	:	REVENUE CYCLE MANAGER
Name	:	KATE WINTER
Credential	:
Telephone Number	:	925-924-7115

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	05/29/2018

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Directions to “HUMANGOOD SOCAL ” Practice Location

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