1992070924 NPI number — REDWOODS RURAL HEALTH CENTER, INC

Table of content: (NPI 1992070924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992070924 NPI number — REDWOODS RURAL HEALTH CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REDWOODS RURAL HEALTH CENTER, 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:
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:
1992070924
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 769
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDWAY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95560-0769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-923-2783
Provider Business Mailing Address Fax Number:
707-923-1688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 5TH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALDERPOINT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-923-2783
Provider Business Practice Location Address Fax Number:
707-923-1688
Provider Enumeration Date:
03/08/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HORNER
Authorized Official First Name:
THAD
Authorized Official Middle Name:
Authorized Official Title or Position:
BOARD PRESIDENT
Authorized Official Telephone Number:
707-923-2783

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  110000099 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1235206087 . This is a "RRHC MAIN SITE MEDI-CAL NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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