REDWOOD COMMUNITY SERVICES, INC (NPI# 1407351653) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407351653 |
| Entity Type | Organization |
| Organization Name | REDWOOD COMMUNITY SERVICES, INC |
| Other Organization Name | MENDOCINO COUNTY CHILDREN'S CENTER (MC3) |
| Practice Address |
110 E Mendocino Ave Willits CA 95490-3508 |
| Mailing Address |
Po Box 2077 Ukiah CA 95482-2077 |
| Practice Telephone | 7074596222 |
| Practice Fax Number | 7074593370 |
| Mailing Telephone | 7074672010 |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2020-01-21 |
| Authorized Official Name | MRS. VICTORIA JERUSHA KELLY (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 7074672010 |
| Authorized Official Credential | LCSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251B00000X | Case Management | Agencies | ||
| N | 251S00000X | Community/Behavioral Health | Agencies | ||
| N | 273Y00000X | Rehabilitation Unit | Hospital Units | ||
| N | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | Residential Treatment Facilities | ||
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | CA DSS-CCL FACILITY NUMBER | 236801878 | 01 |
| Other Name | Type Code |
|---|---|
| Mendocino County Children's Center (MC3) | Other Name - Individual/Organization |
| 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 |
| 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 |
| 1366709461 | Redwood Community Services, Inc | Counselor | 154 S Main St, Lakeport, CA 95453-5017 | 2012-04-13 |
| 1831237015 | Redwood Community Services, Inc | Counselor | 631 S Orchard Ave, Ukiah, CA 95482-5011 | 2007-02-01 |
| Street Address |
110 E MENDOCINO AVE |
| City | WILLITS |
| State | CA |
| Zip Code | 95490-3508 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659524346 | Erika Littlefawn Tsonetokoy Coyle | Counselor | 110 E Mendocino Ave, Willits, CA 95490 | 2008-10-28 |
| 1528546843 | Tony Tucker | Counselor | 110 E Mendocino Ave, Willits, CA 95490-3508 | 2018-07-30 |
| 1407355738 | Erin Donaldson | Counselor | 110 E Mendocino Ave, Willits, CA 95490-3508 | 2018-02-01 |
| 1962910422 | Cinder Benitez | Counselor | 110 E Mendocino Ave, Willits, CA 95490-3508 | 2018-01-18 |
| 1063920999 | Griselda Emery | Counselor | 110 E Mendocino Ave, Willits, CA 95490-3508 | 2018-01-12 |
| 1285140533 | Natalie Sadler | Counselor | 110 E Mendocino Ave, Willits, CA 95490-3508 | 2017-12-22 |
| 1669990867 | Alexander Juarros | Counselor | 110 E Mendocino Ave, Willits, CA 95490-3508 | 2017-09-07 |
| 1194271205 | Nina Elisa Hoffman | Counselor | 110 E Mendocino Ave, Willits, CA 95490 | 2016-08-29 |
| 1609121631 | Heather Marie Gross | Counselor | 110 E Mendocino Ave, Willits, CA 95490-3508 | 2012-07-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679194971 | Laisenia Sau | Specialist | 180 E Barbara Lane, Willits, CA 95490 | 2020-04-28 |
| 1588160527 | Redwood Quality Management Company, Inc. | Community/Behavioral Health | 99 S. Humoldt Street #2, Willits, CA 95490 | 2018-03-30 |
| 1497063861 | Daniel Doyle | Audiologist | 474 E. Valley St., Willits, CA 95490 | 2010-09-20 |
| 1912180548 | Paul F Jacobson | Marriage & Family Therapist | 221-b S. Lenore Avenue, Willits, CA 95490 | 2007-12-05 |
| 1629107735 | Mendocino County | Clinic/Center | 474 East Valley Street, Willits, CA 95490 | 2007-03-05 |
| 1821136482 | Jeff A Cramer | Marriage & Family Therapist | 99 East Humboldt Street, Willits, CA 95490 | 2007-02-02 |
| 1215098215 | Esther Judith Faber | Marriage & Family Therapist | 104 W Mendocino Ave, Willits, CA 95490 | 2006-12-13 |
| 1174684492 | Diana E Levy-peart | Chiropractor | 1225 South Main Street, Willits, CA 95490 | 2006-12-12 |
| 1396810628 | Maria Theresa Bates | Social Worker | Maria T Bates Lcsw, 660 So Main St Suite D, Willits, CA 95490 | 2006-11-21 |
| 1184727620 | Alfred F Kerr | Dentist | 12 W Valley St, Willits, CA 95490 | 2006-09-07 |
| Find all providers in zip 95490 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760819767 | Willow Glen Care Center | Community Based Residential Treatment Facility, Mental Illness | 414 S Main St, Willits, CA 95490-3908 | 2013-10-04 |
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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.