Provider Demographics
NPI:1437850880
Name:GOLD COUNTRY COMMUNITY SERVICES
Entity Type:Organization
Organization Name:GOLD COUNTRY COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVEJOY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:530-615-4541
Mailing Address - Street 1:PO BOX 968
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-0968
Mailing Address - Country:US
Mailing Address - Phone:530-615-4541
Mailing Address - Fax:
Practice Address - Street 1:528 BRUNSWICK RD
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-9392
Practice Address - Country:US
Practice Address - Phone:530-615-4541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals