GARDENSIDE ELDERCARE, LLC (NPI# 1063791713) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063791713 |
| Entity Type | Organization |
| Organization Name | GARDENSIDE ELDERCARE, LLC |
| Practice Address |
529 9th Street Fortuna CA 95540 |
| Mailing Address |
1095 S Fortuna Blvd Ste F Fortuna CA 95540-3067 |
| Practice Telephone | 7077257873 |
| Practice Fax Number | 7072157036 |
| Mailing Telephone | 7077257873 |
| Mailing Fax Number | 7072157036 |
| Enumeration Date | 2011-08-12 |
| Last Update Date | 2011-08-12 |
| Authorized Official Name | MRS. TRINA KELLER (MEMBER) |
| Authorized Official Telephone | 7077257873 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320700000X | Residential Treatment Facility, Physical Disabilities | 126802046 | CA | Residential Treatment Facilities |
| Street Address |
529 9TH STREET |
| City | FORTUNA |
| State | CA |
| Zip Code | 95540 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982234787 | Remi Vista, Inc. | Community/Behavioral Health | 3000 Newburg, Fortuna, CA 95540 | 2020-01-21 |
| 1144867474 | Paula-marie Schneider | Registered Nurse | 3750 Rohnerville Rd., Fortuna, CA 95540 | 2019-12-05 |
| 1609265537 | Nancy Stinson Lollich | Physical Therapy Assistant | 2321 Newburg Road, Fortuna Rehabilitation and Wellness, Fortuna, CA 95540 | 2015-01-15 |
| 1730438151 | Heber House Inc. Dba Dermatology Center | Dermatology | 2404 Newburg Rd., Fortuna, CA 95540 | 2012-08-30 |
| 1104173418 | Michelle Leigh Hoopes | Physician Assistant | 3304 Renner Dr Suite B, Fortuna, CA 95540 | 2012-08-07 |
| 1205181526 | Constance Mitchell | Registered Nurse | Redwood Pediatrics, 3305 Renner Dr, Fortuna, CA 95540 | 2012-07-24 |
| 1730457177 | Joy Nadine Frasier | Counselor | 220 Wilson Ln., Fortuna, CA 95540 | 2011-12-13 |
| 1093025173 | Sheri A Jewett | Massage Therapist | 2655 Virginia Court, Fortuna, CA 95540 | 2010-10-07 |
| 1134371339 | Mariana Van Der Merwe | Pharmacist | 725 South Boulevard, Rite Aid Pharmacy, Fortuna, CA 95540 | 2008-10-21 |
| 1942422688 | Stephanie S Dittmer | Family Medicine | 3750 Rohnerville Road, Fortuna, CA 95540 | 2007-05-03 |
| Find all providers in zip 95540 | ||||
| Taxonomy Code | 320700000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Physical Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881217974 | At Awe LLC | Residential Treatment Facility, Physical Disabilities | 10876 Morning Ridge Dr, Moreno Valley, CA 92557-4202 | 2020-05-22 |
| 1558980896 | Viewcrest Congregate Living | Residential Treatment Facility, Physical Disabilities | 7831 Melita Ave, North Hollywood, CA 91605-1820 | 2020-04-15 |
| 1962046524 | Randy Sarnillo Morelos | Residential Treatment Facility, Physical Disabilities | 9152 Chianti Circle, Stockton, CA 95212 | 2019-11-06 |
| 1518515618 | Dashonia Shaw | Residential Treatment Facility, Physical Disabilities | 3053 N Delno Ave, Fresno, CA 93705-4015 | 2019-08-31 |
| 1114572385 | Twet, LLC | Residential Treatment Facility, Physical Disabilities | 1682 Daybreak Pl, Escondido, CA 92027-1023 | 2019-08-05 |
| 1144873308 | Resurgence California, LLC | Residential Treatment Facility, Physical Disabilities | 3129 Pierce Ave, Costa Mesa, CA 92626-2827 | 2019-07-17 |
| 1891352019 | Mountain View Congregate Living, Inc. | Residential Treatment Facility, Physical Disabilities | 9001 Riderwood Dr, Sunland, CA 91040-2628 | 2019-05-22 |
| 1174014153 | Fresno Congregate Living Inc | Residential Treatment Facility, Physical Disabilities | 3110 E Sierra Ave, Fresno, CA 93710-5917 | 2018-05-24 |
| 1871090803 | Prestige Care Center | Residential Treatment Facility, Physical Disabilities | 474 Sunday Dr, Turlock, CA 95382-9625 | 2018-04-06 |
| 1699281584 | Derani Congregate Living, Inc. | Residential Treatment Facility, Physical Disabilities | 7344 Etiwanda Ave, Reseda, CA 91335-3103 | 2017-12-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.