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General NPI Number Information
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NPI Number | 1922450998
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Entity Type | Organization
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Legal Business Name | RED THREAD INSTITUTE
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Dates
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Enumeration Date | 07/01/2016
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Last Update Date | 07/01/2016
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Provider Practice Location Address
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Address Line | 1819 4TH ST
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City | SANTA ROSA
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State | CA
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Zip | 95404-3202
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Country | US
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Telephone | 707-843-3957
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9145
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City | SANTA ROSA
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State | CA
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Zip | 95405-1145
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Country | US
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Telephone | 707-843-3957
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ISHARA SWEENEY
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Credential | L.AC.
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Telephone | 707-843-3957
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | AC 14291
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License Number State | CA
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