Healthcare Provider Details

I. General information

NPI: 1629583018
Provider Name (Legal Business Name): CLEAR CREEK MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 BUTTE ST
REDDING CA
96001-0852
US

IV. Provider business mailing address

738 SUNRIVER LN
REDDING CA
96001-0166
US

V. Phone/Fax

Practice location:
  • Phone: 530-244-5400
  • Fax:
Mailing address:
  • Phone: 530-355-2670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberA86727
License Number StateCA

VIII. Authorized Official

Name: DR. GREG GREENBERG
Title or Position: CEO
Credential: MD
Phone: 530-355-2670