Healthcare Provider Details

I. General information

NPI: 1972212967
Provider Name (Legal Business Name): SHASTA MEADOWS WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 EAST ST STE 210
REDDING CA
96001-1153
US

IV. Provider business mailing address

1555 EAST ST STE 210
REDDING CA
96001-1153
US

V. Phone/Fax

Practice location:
  • Phone: 530-215-3820
  • Fax: 530-215-3745
Mailing address:
  • Phone: 415-713-6654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES ROSS TAGGART
Title or Position: OWNER
Credential: MD
Phone: 530-215-3820