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NPI Code Detail

MEDICARE: REDWOOD COMMUNITY SERVICES, INC.

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 License Number License Number State
1106H00000XMarriage & Family Therapist
2171M00000XCase Manager/Care Coordinator
3251B00000XCase Management Agency
4101Y00000XCounselor
5101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
149EF1OTHERCASONOMA CO PROVIDER NO.
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
323BBOTHERCAMENDOCINO CO MH SITE #

General Provider Information

NPI Number : 1285772251
Entity Type Code : Organization
Provider Name (Legal Business Name) : REDWOOD COMMUNITY SERVICES, INC.
Provider Business Mailing Address
First Line : PO BOX 2077
Second Line :
City : UKIAH
State : CA
Zip : 95482
Country : US
Telephone Number : 707-462-5056
Fax Number : 707-462-5205
Provider Business Practice Location Address
First Line : 6150 ORR SPRINGS RD
Second Line :
City : UKIAH
State : CA
Zip : 95482-9032
Country : US
Telephone Number : 707-462-5056
Fax Number : 707-462-5205
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MRS. VICTORIA JERSUHA KELLY
Credential : LCSW
Telephone Number : 707-462-2010
Provider Enumeration Date : 02/02/2007
Last Update Date : 01/21/2020

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Directions to “REDWOOD COMMUNITY SERVICES, INC. ” Practice Location

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