=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336939966
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REDWOOD GOSPEL MISSIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2025
-----------------------------------------------------
Last Update Date | 05/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 6TH ST
-----------------------------------------------------
City | SANTA ROSA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95401-6218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-542-4187
-----------------------------------------------------
Fax | 707-544-6185
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 493
-----------------------------------------------------
City | SANTA ROSA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95402-0493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-578-1830
-----------------------------------------------------
Fax | 707-578-4841
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GUEST SERVICES MANAGER
-----------------------------------------------------
Name | MR. CHRISTIAN JAMES CROSSLAND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 707-679-8375
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------