Healthcare Provider Details

I. General information

NPI: 1093262305
Provider Name (Legal Business Name): THE REDWOOD FAMILY INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2016
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E OCEAN AVE SUITE E
LOMPOC CA
93436-6926
US

IV. Provider business mailing address

PO BOX 992
LOMPOC CA
93438-0992
US

V. Phone/Fax

Practice location:
  • Phone: 805-819-0007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. PETER T MOSGOFIAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 805-819-0007