Provider Demographics
NPI:1902839962
Name:DUMOLIN SERVICE CORP.
Entity Type:Organization
Organization Name:DUMOLIN SERVICE CORP.
Other - Org Name:DUMOLIN COMMUNITY LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-838-2300
Mailing Address - Street 1:7852 BELL ROAD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492
Mailing Address - Country:US
Mailing Address - Phone:707-838-2300
Mailing Address - Fax:707-838-2305
Practice Address - Street 1:7852 BELL ROAD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492
Practice Address - Country:US
Practice Address - Phone:707-838-2300
Practice Address - Fax:707-838-2305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC60461FMedicaid
CALTC60468FMedicaid
CALTC60437GMedicaid
CALTC60319GMedicaid
CALTC60567FMedicaid
CALTC60785FMedicaid
CALTC80175FMedicaid
CALTC60457FMedicaid
CALTC80194FMedicaid