Provider Demographics
NPI:1649607664
Name:REDWOOD COAST PACE
Entity type:Organization
Organization Name:REDWOOD COAST PACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS
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:707-443-3498
Practice Address - Street 1:1901 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-2809
Practice Address - Country:US
Practice Address - Phone:707-443-9747
Practice Address - Fax:707-443-3498
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUMBOLDT SENIOR RESOURCE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMSS00009FMedicaid
CA1164644746Medicaid