Healthcare Provider Details

I. General information

NPI: 1255269866
Provider Name (Legal Business Name): PHR SURGICAL HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 EUREKA WAY
REDDING CA
96001-0220
US

IV. Provider business mailing address

2900 EUREKA WAY
REDDING CA
96001-0220
US

V. Phone/Fax

Practice location:
  • Phone: 530-225-8700
  • Fax:
Mailing address:
  • Phone: 530-225-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: CLEVONNE M JACOBS
Title or Position: COUNSEL
Credential: ESQ.
Phone: 615-429-0601