MEDICARE: NORTH VALLEY DEVELOPMENTAL 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
1	315P00000X	Intellectual Disabilities Intermediate Care Facility	230000310	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598739062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH VALLEY DEVELOPMENTAL SERVICES INC

Provider Business Mailing Address
First Line	:	PO BOX 492478
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96049
Country	:	US
Telephone Number	:	530-226-0375
Fax Number	:	530-365-1609

Provider Business Practice Location Address
First Line	:	WALKER LANE
Second Line	:
City	:	SHASTA LAKE CITY
State	:	CA
Zip	:	96019
Country	:	US
Telephone Number	:	530-226-0375
Fax Number	:	530-365-1609

Authorized Official
Title or Position	:	CFO OWNER
Name	:	MR. GARY M GREEN
Credential	:
Telephone Number	:	530-226-0375

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	08/08/2008

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