MEDICARE: REDWOOD COMMUNITY SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	251B00000X	Case Management Agency
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
4	253J00000X	Foster Care Agency
5	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility
6	252Y00000X	Early Intervention Provider Agency
7	320800000X	Mental Illness Community Based Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	23BV	OTHER	CA	MH SITE CERT - MENDOCINO COUNTY MH

General Provider Information

NPI Number	:	1174778674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDWOOD COMMUNITY SERVICES, INC

Provider Business Mailing Address
First Line	:	PO BOX 2077
Second Line	:	631 S. ORCHARD ST
City	:	UKIAH
State	:	CA
Zip	:	95482-2077
Country	:	US
Telephone Number	:	707-467-2010
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 GIBSON ST
Second Line	:
City	:	UKIAH
State	:	CA
Zip	:	95482-3941
Country	:	US
Telephone Number	:	707-462-4770
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MRS. VICTORIA JERUSHA KELLY
Credential	:	LCSW
Telephone Number	:	707-467-2010

Provider Enumeration Date	:	11/25/2008
Last Update Date	:	06/08/2026

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Directions to “REDWOOD COMMUNITY SERVICES, INC ” Practice Location

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