Provider Demographics
NPI:1467717249
Name:COMMON GOALS
Entity Type:Organization
Organization Name:COMMON GOALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DRUG COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BORDENAVE
Authorized Official - Suffix:III
Authorized Official - Credentials:CSAC
Authorized Official - Phone:530-344-6457
Mailing Address - Street 1:727 ZION ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-2920
Mailing Address - Country:US
Mailing Address - Phone:530-265-2914
Mailing Address - Fax:530-265-2974
Practice Address - Street 1:727 ZION ST
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2920
Practice Address - Country:US
Practice Address - Phone:530-265-2914
Practice Address - Fax:530-265-2974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAN/AOtherN/A