Provider Demographics
NPI:1336490069
Name:COMMON GOALS, INC.
Entity Type:Organization
Organization Name:COMMON GOALS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:FESTERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-265-2914
Mailing Address - Street 1:256 BUENA VISTA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-7239
Mailing Address - Country:US
Mailing Address - Phone:530-274-2000
Mailing Address - Fax:530-274-2116
Practice Address - Street 1:256 BUENA VISTA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-7239
Practice Address - Country:US
Practice Address - Phone:530-274-2000
Practice Address - Fax:530-274-2116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA292902Medicaid