Provider Demographics
NPI:1508942111
Name:FRIENDS ASSOC OF SERVICES FOR THE ELDERLY
Entity Type:Organization
Organization Name:FRIENDS ASSOC OF SERVICES FOR THE ELDERLY
Other - Org Name:FRIENDS HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. DIRECTOR RISK MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:EDELSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-956-7360
Mailing Address - Street 1:684 BENICIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-3058
Mailing Address - Country:US
Mailing Address - Phone:707-538-0152
Mailing Address - Fax:707-573-4528
Practice Address - Street 1:684 BENICIA DRIVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-3058
Practice Address - Country:US
Practice Address - Phone:707-538-0152
Practice Address - Fax:707-573-4528
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRONT PORCH COMMUNITIES AND SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-27
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555168Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER