1386164580 NPI number — REDDING RANCHERIA

Table of content: (NPI 1386164580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386164580 NPI number — REDDING RANCHERIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REDDING RANCHERIA
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:
1386164580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1441 LIBERTY ST
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:
96001-0811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-224-2700
Provider Business Mailing Address Fax Number:
530-224-2738

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
81 ARBUCKLE COURT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEAVERVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-623-0021
Provider Business Practice Location Address Fax Number:
530-623-0025
Provider Enumeration Date:
06/20/2017

Additional Information

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
LORI
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
530-226-1740

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100267288 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com