Healthcare Provider Details

I. General information

NPI: 1871252569
Provider Name (Legal Business Name): REDDING RANCHERIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 CHURN CREEK RD
REDDING CA
96002-2101
US

IV. Provider business mailing address

1441 LIBERTY ST
REDDING CA
96001-0811
US

V. Phone/Fax

Practice location:
  • Phone: 530-226-1740
  • Fax: 530-224-2738
Mailing address:
  • Phone: 530-226-1740
  • Fax: 530-224-2738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: TAMRA DAWN OLSON
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 530-242-4523