1891859047 NPI number — REDWOOD COMMUNITY SERVICES, INC.

Table of content: (NPI 1891859047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891859047 NPI number — REDWOOD COMMUNITY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REDWOOD COMMUNITY SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RCS BEHAVIORAL HEALTH SERVICES
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891859047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2077
Provider Second Line Business Mailing Address:
631 S. ORCHARD STREET
Provider Business Mailing Address City Name:
UKIAH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95482-2077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-467-2010
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEPORT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-263-0372
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KELLY
Authorized Official First Name:
VICTORIA
Authorized Official Middle Name:
JERUSHA
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
707-467-2010

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01164707 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 49EC1 . This is a "SONOMA CO PROVIDER NO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 01816207 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5878 . This is a "SUTTER-YUBA CO PROVIDER NO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1791 . This is a "LAKE CO. MH SITE #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 0851 . This is a "DEL NORTE CO PROVIDER NO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 27A7 . This is a "NAPA CO SITE #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 01726307 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2377 . This is a "MENDOCINO CO. PROVIDER NO." identifier . This identifiers is of the category "OTHER".




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