Healthcare Provider Details

I. General information

NPI: 1316724180
Provider Name (Legal Business Name): CHILDREN'S LEGACY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 BENTON DR
REDDING CA
96003-5350
US

IV. Provider business mailing address

1095 HILLTOP DR # 369
REDDING CA
96003-3811
US

V. Phone/Fax

Practice location:
  • Phone: 530-244-0117
  • Fax:
Mailing address:
  • Phone: 530-768-1880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH SCHROEDER
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 530-232-0535