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Organization

GARDENSIDE ELDERCARE, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. TRINA KELLER (MEMBER)
(707) 725-7873
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
126802046
CA

Other

Enumeration date
08/12/2011
Last updated
08/12/2011
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