Organization
HUMANGOOD NORCAL
Active
Other names
Plymouth Village
Organization subpart
No
Provider details
NPI number
Authorized official
GWEN VANGELISTO (DIRECTOR OF ACCOUNTS RECEIVABLE)
(949) 463-0893
Entity
Organization
Contact information
Practice address
819 SALEM DR, REDLANDS, CA 92373
(909) 793-1233
(909) 798-5504
Mailing address
1900 HUNTINGTON DR, DUARTE, CA 91010-2694
(818) 247-0420
(949) 463-0893
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
240000189
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZT05914G
—
CA
Enumeration date
10/05/2005
Last updated
06/02/2025
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