1205668191 NPI number — NATIVE AMERICAN MENTAL HEALTH SERVICES CORPORATION

Table of content: (NPI 1205668191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205668191 NPI number — NATIVE AMERICAN MENTAL HEALTH SERVICES CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIVE AMERICAN MENTAL HEALTH SERVICES CORPORATION
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:
Provider Other Organization Name Type Code:
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:
1205668191
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2165 LARKSPUR LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDDING
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96002-0600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-226-7419
Provider Business Mailing Address Fax Number:
530-262-6849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED BLUFF
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96080-4316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-292-8080
Provider Business Practice Location Address Fax Number:
530-262-6849
Provider Enumeration Date:
08/19/2024

Additional Information

Authorized Official

Authorized Official Last Name:
KINNEY
Authorized Official First Name:
BENTON
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
530-226-7419

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com