Provider Demographics
NPI:1376869602
Name:TRI-COUNTY INDEPENDENT LIVING
Entity Type:Organization
Organization Name:TRI-COUNTY INDEPENDENT LIVING
Other - Org Name:HUMBOLDT ACCESS PROJECT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-445-8404
Mailing Address - Street 1:2822 HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4809
Mailing Address - Country:US
Mailing Address - Phone:707-445-8404
Mailing Address - Fax:707-445-9751
Practice Address - Street 1:2822 HARRIS ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4809
Practice Address - Country:US
Practice Address - Phone:707-445-8404
Practice Address - Fax:707-445-9751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management