NPIMap

Organization Active NPI

Redwood Community Services, Inc

  • Substance Abuse Rehabilitation Facility
  • Upper Lake, CA
National Provider Identifier
1265897029
Registry record updated Jan 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
REDWOOD COMMUNITY SERVICES, INC
Practice address
675 1St St
Upper Lake, CA 95485
Phone
(707) 275-8776
NPI assigned
Dec 22, 2015
Last updated
Jan 21, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
REDWOOD COMMUNITY SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 21, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Victoria Jersuha Kelly, LCSWNPI 1801125844
Title
Chief Executive Officer
Phone
(707) 467-2010

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Substance Abuse Rehabilitation Facility 324500000X Primary
Early Intervention Provider Agency 252Y00000X
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

675 1St St
Upper Lake, CA 95485

Mailing address

PO Box 2077
631 S. Orchard Street
Ukiah, CA 95482-2077
Phone (707) 467-2010

Other names 1

  • H.O.M.E. Tule House Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160908002886 CA Part B Supplier - Clinic/Group Practice 7618263187 Receives reassigned benefits from 11 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ukiah, CA; Upper Lake, CA; Willits, CA; Redwood Valley, CA; Fort Bragg, CA; Lakeport, CA

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Redwood Community Services29 organizations share this tax ID, including this one
Part of
Redwood Community Services

Other organizations with this tax ID 28

Organizations that report the same tax identification number in the National Provider Directory.

View all 28

Locations

810 N State St
Ukiah, CA 95482
Phone (707) 462-2922

675 1st St
Upper Lake, CA 95485
Phone (707) 263-3116

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1450742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579564800000",
    "number": "1265897029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2077",
            "address_2": "631 S. ORCHARD STREET",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954822077",
            "telephone_number": "707-467-2010",
            "fax_number": "707-463-4931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 1ST ST",
            "city": "UPPER LAKE",
            "state": "CA",
            "postal_code": "95485",
            "telephone_number": "707-275-8776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDWOOD COMMUNITY SERVICES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "REDWOOD COMMUNITY SERVICES, INC.",
        "enumeration_date": "2015-12-22",
        "last_updated": "2020-01-21",
        "certification_date": "2020-01-21",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_middle_name": "JERSUHA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "707-467-2010",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "H.O.M.E. Tule House",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "H.O.M.E. Tule House",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Upper Lake, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.