Healthcare Provider Details

I. General information

NPI: 1982607065
Provider Name (Legal Business Name): MEDICAL HOME SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 CHURN CREEK RD
REDDING CA
96002-0732
US

IV. Provider business mailing address

2115 CHURN CREEK RD
REDDING CA
96002-0732
US

V. Phone/Fax

Practice location:
  • Phone: 530-226-5577
  • Fax: 530-226-5585
Mailing address:
  • Phone: 530-226-5577
  • Fax: 530-226-5585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number230000178
License Number StateCA

VIII. Authorized Official

Name: MRS. KATHY MCKILLOP
Title or Position: PRESIDENT
Credential: LVN
Phone: 530-226-5577