REDWOOD COMMUNITY SERVICES, INC (NPI# 1366709461) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366709461 |
| Entity Type | Organization |
| Organization Name | REDWOOD COMMUNITY SERVICES, INC |
| Practice Address |
154 S Main St Lakeport CA 95453-5017 |
| Mailing Address |
Po Box 2077 Ukiah CA 95482-2077 |
| Practice Telephone | 7072630372 |
| Mailing Telephone | 7074672010 |
| Mailing Fax Number | 7074672009 |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2020-02-12 |
| Authorized Official Name | MRS. VICTORIA JERUSHA KELLY (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 7074672010 |
| Authorized Official Credential | LCSW |
| Is Organization Subpart | Y |
| Parent Organization Name | REDWOOD COMMUNITY SERVICES, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| N | 101Y00000X | Counselor | Behavioral Health & Social Service Providers | ||
| N | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| N | 106H00000X | Marriage & Family Therapist | Behavioral Health & Social Service Providers | ||
| N | 251B00000X | Case Management | Agencies | ||
| N | 251S00000X | Community/Behavioral Health | Agencies | ||
| N | 276400000X | Rehabilitation, Substance Use Disorder Unit | Hospital Units | ||
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 1791 | 05 | |
| CA | CALOMS # | 171721 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 320 1st St, Lakeport, CA 95453 | 7072633116 | 7072633117 |
| 390 N Forbes St, Lakeport, CA 954534724 | 7072633116 | 7072633117 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558702795 | Redwood Community Services, Inc | Community/Behavioral Health | 800 N. State Street, (rcs - Mffa / Tfc), Ukiah, CA 95482 | 2013-07-16 |
| 1174778674 | Redwood Community Services, Inc | Case Management | 150 Gibson St, Ukiah, CA 95482-3941 | 2008-11-25 |
| 1407351653 | Redwood Community Services, Inc | Case Management | 110 E Mendocino Ave, Willits, CA 95490-3508 | 2018-03-29 |
| 1518418482 | Redwood Community Services, Inc | Counselor | 9981b Spring Valley Rd, Potter Valley, CA 95469-9713 | 2016-10-17 |
| 1265897029 | Redwood Community Services, Inc | Case Management | 675 1st St, Upper Lake, CA 95485 | 2015-12-22 |
| 1528496619 | Redwood Community Services, Inc | Private Vehicle | 544 S Main St, Fort Bragg, CA 95437-5107 | 2013-10-29 |
| 1831237015 | Redwood Community Services, Inc | Counselor | 631 S Orchard Ave, Ukiah, CA 95482-5011 | 2007-02-01 |
| Street Address |
154 S MAIN ST |
| City | LAKEPORT |
| State | CA |
| Zip Code | 95453-5017 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205302577 | Angelina Fagundo | Counselor | 154 S Main St, Lakeport, CA 95453-5017 | 2018-10-15 |
| 1336414929 | Kimbralee Guerra | Counselor | 154 S Main St, Lakeport, CA 95453-5017 | 2012-03-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427526847 | Easter Seals Bay Area | Early Intervention Provider Agency | 1950 Parallel Drive, Lakeport, CA 95453 | 2018-11-03 |
| 1285000810 | Lake County Tribal Health Consortium, Inc. | Clinic/Center | 14678 Lakeshore Boulevard, Clearlake, CA 95453 | 2015-08-18 |
| 1942558721 | Lorena A Watson | Nurse Practitioner | 5108 Hill Road East, Lakeport, CA 95453 | 2012-08-27 |
| 1992024657 | Jennifer Stolworthy Smith | Case Manager/Care Coordinator | 991 Parallel Dr. Ste. B, County of Lake, Mental Health, Lakeport, CA 95453 | 2010-05-20 |
| 1376720664 | June Arisa Masato | Marriage & Family Therapist | 1152 S. Main St, Lakeport, CA 95453 | 2008-01-29 |
| 1245417021 | Robert Ryan Taylor Sr. | Physical Therapist | 1285 S Main Street, Lakeport, CA 95453 | 2008-01-24 |
| 1760669618 | Joan Kammerer | Registered Nurse | 922 Bevins Court, Lakeport, CA 95453 | 2008-01-23 |
| 1881878353 | Mary Theresa Mcmillan | Marriage & Family Therapist | 75 Fourth Street, Lakeport, CA 95453 | 2007-12-19 |
| 1922288984 | Robert William Krause | Family Medicine | 755 Eleventh St, Lakeport, CA 95453 | 2007-11-07 |
| 1568683092 | Dan Sleeth | Marriage & Family Therapist | 991 Parallel Dr., Lakeport, CA 95453 | 2007-05-01 |
| Find all providers in zip 95453 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.