NPIMap

Organization Active NPI

Redwood Community Services, Inc.

  • Community/Behavioral Health Agency
  • Lakeport, CA
National Provider Identifier
1336387455
Registry record updated Feb 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
REDWOOD COMMUNITY SERVICES, INC.
Practice address
150 S Main St
Lakeport, CA 95453-5017
Phone
(707) 994-5486
NPI assigned
Jan 27, 2009
Last updated
Feb 12, 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 Feb 12, 2020

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

Authorized official

Name
Mrs. Victoria Jerusha Kelly, LMFTNPI 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 7

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X NU
Counselor 101Y00000X NU
Clinical Social Worker 1041C0700X NU
Marriage & Family Therapist 106H00000X NU
Contractor 171W00000X NU
Case Manager/Care Coordinator 171M00000X NU
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

150 S Main St
Lakeport, CA 95453-5017

Mailing address

PO Box 2077
Ukiah, CA 95482-2077
Phone (707) 467-2010

Other practice location 1

16170 Main Street
Suite F
Lower Lake, CA 95457
Phone (707) 994-5486

Other identifiers 1

IdentifierTypeStateIssuer
17CCOtherCALAKE CO MH SITE #

Other names 1

  • The Harbor on Main 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
Part of
Redwood Community Services

Locations

150 S Main St
Lakeport, CA 95453
Phone (707) 263-0372

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1233014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581465600000",
    "number": "1336387455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2077",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954822077",
            "telephone_number": "707-467-2010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 S MAIN ST",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954535017",
            "telephone_number": "707-994-5486"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16170 Main Street",
            "address_2": "Suite F",
            "address_purpose": "LOCATION",
            "city": "Lower Lake",
            "state": "CA",
            "postal_code": "95457",
            "country_code": "US",
            "telephone_number": "707-994-5486",
            "fax_number": "707-995-1841",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REDWOOD COMMUNITY SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "REDWOOD COMMUNITY SERVICES, INC.",
        "enumeration_date": "2009-01-27",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_middle_name": "JERUSHA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "707-467-2010",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LAKE CO MH SITE #",
            "identifier": "17CC",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Harbor on Main",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lakeport, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 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.