Provider Demographics
NPI:1578550372
Name:HUMANGOOD NORCAL
Entity Type:Organization
Organization Name:HUMANGOOD NORCAL
Other - Org Name:PLYMOUTH VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-924-7115
Mailing Address - Street 1:819 SALEM DR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-8502
Mailing Address - Country:US
Mailing Address - Phone:909-793-1233
Mailing Address - Fax:909-798-5504
Practice Address - Street 1:819 SALEM DR
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373
Practice Address - Country:US
Practice Address - Phone:909-793-1233
Practice Address - Fax:909-798-5504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000189314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT05914GMedicaid
CA055914Medicare ID - Type UnspecifiedFEDERAL NUMBER