Healthcare Provider Details

I. General information

NPI: 1881692390
Provider Name (Legal Business Name): COUNTY OF SHASTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 BRESLAUER WAY
REDDING CA
96001-4246
US

IV. Provider business mailing address

PO BOX 496048
REDDING CA
96049-6048
US

V. Phone/Fax

Practice location:
  • Phone: 530-225-5200
  • Fax: 530-225-5977
Mailing address:
  • Phone: 530-225-5200
  • Fax: 530-225-5977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MIGUEL RODRIGUEZ
Title or Position: DIRECTOR OF MENTAL HEALTH
Credential:
Phone: 530-225-5965