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	251B00000X	Case Management Agency
2	252Y00000X	Early Intervention Provider Agency
3	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)
4	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
5	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	23CX	OTHER		MEDICAL SPMH PROVIDER CERTIFICATION NUMBER

General Provider Information

NPI Number	:	1982017844
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	:	95482-2077
Country	:	US
Telephone Number	:	707-467-2010
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 GIBSON ST
Second Line	:
City	:	UKIAH
State	:	CA
Zip	:	95482-3941
Country	:	US
Telephone Number	:	707-462-7267
Fax Number	:	707-462-2789

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

Provider Enumeration Date	:	06/09/2014
Last Update Date	:	01/08/2024

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

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