Healthcare Provider Details

I. General information

NPI: 1487578365
Provider Name (Legal Business Name): RESTPADD MENDOCINO COAST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 S STATE ST
UKIAH CA
95482-6923
US

IV. Provider business mailing address

2750 EUREKA WAY
REDDING CA
96001-0223
US

V. Phone/Fax

Practice location:
  • Phone: 530-262-6700
  • Fax:
Mailing address:
  • Phone: 530-262-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: ROBERT EDGAR
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: RN
Phone: 530-262-6700