Healthcare Provider Details

I. General information

NPI: 1528102282
Provider Name (Legal Business Name): REDDING RANCHERIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 LIBERTY ST
REDDING CA
96001-0848
US

IV. Provider business mailing address

1441 LIBERTY ST
REDDING CA
96001-0848
US

V. Phone/Fax

Practice location:
  • Phone: 530-224-2700
  • Fax: 530-224-2726
Mailing address:
  • Phone: 530-224-2700
  • Fax: 530-224-2726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License NumberPHE38097
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GLEN HAYWARD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 530-226-1737