Provider Demographics
NPI:1346219037
Name:UNITED COM-SERVE
Entity Type:Organization
Organization Name:UNITED COM-SERVE
Other - Org Name:FREMONT - RIDEOUT HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-751-4278
Mailing Address - Street 1:939 LIVE OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4002
Mailing Address - Country:US
Mailing Address - Phone:530-673-7100
Mailing Address - Fax:530-673-7886
Practice Address - Street 1:939 LIVE OAK BLVD
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4002
Practice Address - Country:US
Practice Address - Phone:530-673-7100
Practice Address - Fax:530-673-7886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000143251E00000X
CA230000211251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA07448GMedicaid
CAHHA07091FMedicaid
CAHHA07091FMedicaid
CA057448Medicare Oscar/Certification