=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003950668
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE SALVATION ARMY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 117 C ST SUITE 100
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95901-6015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-743-7313
-----------------------------------------------------
Fax | 530-671-7213
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 869
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95901-0869
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-671-7283
-----------------------------------------------------
Fax | 530-671-7213
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CORPS OFFICER
-----------------------------------------------------
Name | MR. DARREN S STRATTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 530-671-7283
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------