# GARDENSIDE ELDERCARE, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063791713
- **Authorized official:** MRS. TRINA KELLER (MEMBER)
- **Authorized official phone:** (707) 725-7873

## Contact information

- **Practice address:** 529 9TH STREET, FORTUNA, CA 95540
- **Practice address phone:** (707) 725-7873
- **Practice address fax:** (707) 215-7036
- **Mailing address:** 1095 S FORTUNA BLVD STE F, FORTUNA, CA 95540-3067
- **Mailing address phone:** (707) 725-7873
- **Mailing address fax:** (707) 215-7036

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320700000X | Physical Disabilities Residential Treatment Facility | 126802046 | CA | Yes |

## Other

- **Enumeration date:** 08/12/2011
- **Last updated:** 08/12/2011