Basic Information
Provider Information | |||||||||
NPI: | 1982810107 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | TEHAMA COUNTY HEALTH SERVICES AGENCY | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 400 | ||||||||
Address2: |   | ||||||||
City: | RED BLUFF | ||||||||
State: | CA | ||||||||
PostalCode: | 960800400 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5305278491 | ||||||||
FaxNumber: | 5305270240 | ||||||||
Practice Location | |||||||||
Address1: | 818 MAIN ST | ||||||||
Address2: |   | ||||||||
City: | RED BLUFF | ||||||||
State: | CA | ||||||||
PostalCode: | 960802759 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5305278491 | ||||||||
FaxNumber: | 5305270240 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/15/2007 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | LUCERO | ||||||||
AuthorizedOfficialFirstName: | VALERIE | ||||||||
AuthorizedOfficialMiddleName: | S. | ||||||||
AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 5305278491 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X |   |   | X |   | Agencies | Community/Behavioral Health |   | 261Q00000X |   |   | X |   | Ambulatory Health Care Facilities | Clinic/Center |   | 261QP0905X |   |   | X |   | Ambulatory Health Care Facilities | Clinic/Center | Public Health, State or Local |
No ID Information.