1215193149 NPI number — FAMILY SERVICE AGENCY OF TEHAMA COUNTY

Table of content: (NPI 1215193149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215193149 NPI number — FAMILY SERVICE AGENCY OF TEHAMA COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY SERVICE AGENCY OF TEHAMA COUNTY
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:
6
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:
1215193149
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1112 WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RED BLUFF
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96080-2749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-527-6702
Provider Business Mailing Address Fax Number:
530-527-7658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1347 GRANT 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:
96080-2366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-527-6702
Provider Business Practice Location Address Fax Number:
530-527-7658
Provider Enumeration Date:
07/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
POULSEN
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
530-527-6702

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com