Provider Demographics
NPI:1538445358
Name:REDWOOD COMMUNITY SERVICES, INC.
Entity type:Organization
Organization Name:REDWOOD COMMUNITY SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:JERSUHA
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:707-467-2010
Mailing Address - Street 1:PO BOX 2077
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-2077
Mailing Address - Country:US
Mailing Address - Phone:707-467-2010
Mailing Address - Fax:707-467-2009
Practice Address - Street 1:7351 SEMS LN
Practice Address - Street 2:
Practice Address - City:REDWOOD VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95470
Practice Address - Country:US
Practice Address - Phone:707-467-9192
Practice Address - Fax:707-467-9345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
320800000X
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA23CIOtherMENDOCINO COUNTY PROVIDER NUMBER
CA236803765OtherCCL