Provider Demographics
NPI:1700405693
Name:NORTH COAST NURTURE CENTER
Entity Type:Organization
Organization Name:NORTH COAST NURTURE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARAHONA RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-601-5622
Mailing Address - Street 1:1225 CENTRAL AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-4390
Mailing Address - Country:US
Mailing Address - Phone:707-601-5622
Mailing Address - Fax:707-840-6036
Practice Address - Street 1:1225 CENTRAL AVE STE 2
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-4390
Practice Address - Country:US
Practice Address - Phone:707-601-5622
Practice Address - Fax:707-840-6036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)