Provider Demographics
NPI:1356599278
Name:HUMBOLDT SENIOR RESOURCE CENTER INCORPORATED
Entity type:Organization
Organization Name:HUMBOLDT SENIOR RESOURCE CENTER INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-443-9747
Mailing Address - Street 1:1910 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-2870
Mailing Address - Country:US
Mailing Address - Phone:707-443-9747
Mailing Address - Fax:707-443-7277
Practice Address - Street 1:626 H ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1026
Practice Address - Country:US
Practice Address - Phone:707-443-9747
Practice Address - Fax:707-443-7277
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUMBOLDT SENIOR RESOURCE CENTER INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-04
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251B00000X
261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251B00000XAgenciesCase Management