Healthcare Provider Details

I. General information

NPI: 1649466640
Provider Name (Legal Business Name): HSS 1 STOP BIG VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 HWY 299 E.
BIEBER CA
96009
US

IV. Provider business mailing address

555 HOSPITAL LN
SUSANVILLE CA
96130-4808
US

V. Phone/Fax

Practice location:
  • Phone: 530-251-8108
  • Fax:
Mailing address:
  • Phone: 530-251-8108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. KEN CRANDALL
Title or Position: DIRECTOR OF MENTAL HEALTH SERVICES
Credential: A.S.W.
Phone: 530-251-8108