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General NPI Number Information
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NPI Number | 1245628411
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Entity Type | Organization
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Legal Business Name | DEPT. OF VETERAN'S AFFAIRS
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Dates
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Enumeration Date | 12/22/2014
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Last Update Date | 12/22/2014
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Provider Practice Location Address
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Address Line | 351 HARTNELL AVE
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City | REDDING
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State | CA
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Zip | 96002-1845
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Country | US
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Telephone | 530-247-7944
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Fax |
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Provider Business Mailing Address
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Address Line | 351 HARTNELL AVE
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City | REDDING
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State | CA
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Zip | 96002-1845
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Country | US
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Telephone | 530-247-7944
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | CELESTE CLARK
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Credential |
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Telephone | 916-640-8050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number | N-45751
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License Number State | ID
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