Provider Demographics
NPI:1659356111
Name:HUMANGOOD NORCAL
Entity Type:Organization
Organization Name:HUMANGOOD NORCAL
Other - Org Name:TERRACES OF LOS GATOS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:MS
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 1:6120 STONERIDGE MALL RD FL 3
Mailing Address - Street 2:ABHOW
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3296
Mailing Address - Country:US
Mailing Address - Phone:925-924-7100
Mailing Address - Fax:925-924-7101
Practice Address - Street 1:800 BLOSSOM HILL RD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032
Practice Address - Country:US
Practice Address - Phone:408-356-1006
Practice Address - Fax:408-356-9647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000326314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55547FMedicaid
CA555547Medicare ID - Type UnspecifiedMEDICARE NUMBER