Healthcare Provider Details

I. General information

NPI: 1073754347
Provider Name (Legal Business Name): CHICO STATE ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MAIN ST SUITE 202
CHICO CA
95929-1000
US

IV. Provider business mailing address

25 MAIN ST UNIT 103
CHICO CA
95928-5388
US

V. Phone/Fax

Practice location:
  • Phone: 530-898-5923
  • Fax: 530-898-4870
Mailing address:
  • Phone: 530-898-6811
  • Fax: 530-898-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL WITTMEIER RUSSELL WITTMEIER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 530-898-5731