Provider Demographics
NPI:1063901767
Name:HUMBOLDT MOBILE MASSAGE, INC
Entity type:Organization
Organization Name:HUMBOLDT MOBILE MASSAGE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:CLD
Authorized Official - Phone:707-832-2929
Mailing Address - Street 1:600 F ST
Mailing Address - Street 2:STE 3 PMB 700
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521
Mailing Address - Country:US
Mailing Address - Phone:707-832-2929
Mailing Address - Fax:707-306-7292
Practice Address - Street 1:350 E ST STE 205
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-0378
Practice Address - Country:US
Practice Address - Phone:707-832-2929
Practice Address - Fax:707-968-4779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider OrganizationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1588442552Medicaid