| Harstad House | |
|
1120 Gordon Ln Santa Rosa CA 95404-5636 | |
| (707) 255-9028 | |
| (707) 255-3715 |
| Full Name | Harstad House |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1120 Gordon Ln, Santa Rosa, California |
| Authorized Official Name and Position | Bernadette Santiago Navarro-simeon (DIRECTOR OF CLINICAL ADMINISTRATION) |
| Authorized Official Contact | 4158610828 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Harstad House 368 Fell St San Francisco CA 94102-5144 Ph: (415) 861-0828 | Harstad House 1120 Gordon Ln Santa Rosa CA 95404-5636 Ph: (707) 255-9028 |
| NPI Number | 1679025472 |
|---|---|
| Provider Enumeration Date | 10/27/2016 |
| Last Update Date | 10/12/2022 |
| Certification Date | 10/12/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679025472 | NPI | - | NPPES |
| 49GH5 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 496803654 (California) | Primary |
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