Healthcare Provider Details

I. General information

NPI: 1538181557
Provider Name (Legal Business Name): SHASTA COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 INDUSTRIAL ST
REDDING CA
96002-0757
US

IV. Provider business mailing address

PO BOX 992790
REDDING CA
96099-2790
US

V. Phone/Fax

Practice location:
  • Phone: 530-246-5894
  • Fax: 530-241-7838
Mailing address:
  • Phone: 530-246-5894
  • Fax: 530-241-7838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number230000297
License Number StateCA

VIII. Authorized Official

Name: MR. JEFFERY BRANDON THORNOCK
Title or Position: CEO
Credential:
Phone: 530-246-5710