NPIMap

Organization Active NPI

Redwood Community Services, Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Lakeport, CA
National Provider Identifier
1366709461
Registry record updated Dec 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
REDWOOD COMMUNITY SERVICES, INC
Practice address
154 S Main St
Lakeport, CA 95453-5017
Phone
(707) 263-0372
NPI assigned
Apr 13, 2012
Organization subpart
Yes
Parent organization
REDWOOD COMMUNITY SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 10, 2020

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

Authorized official

Name
Mrs. Victoria Jerusha Kelly, LCSW
Title
Chief Executive Officer
Phone
(707) 467-2010

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X
Case Management Agency 251B00000X
Community/Behavioral Health Agency 251S00000X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary
Substance Use Disorder Rehabilitation Hospital Unit 276400000X

Addresses

Primary practice location

154 S Main St
Lakeport, CA 95453-5017

Mailing address

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

Other practice location 1

390 N Forbes St
Lakeport, CA 95453-4724
Phone (707) 263-3116

Other practice location 2

320 1st St
Lakeport, CA 95453
Phone (707) 263-3116

Other identifiers 1

IdentifierTypeStateIssuer
171721OtherCACALOMS #

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

390 N Forbes St
Lakeport, CA 95453
Phone (707) 263-3116

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

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

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1334275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607558400000",
    "number": "1366709461",
    "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",
            "fax_number": "707-467-2009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "154 S MAIN ST",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954535017",
            "telephone_number": "707-263-0372"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "390 N Forbes St",
            "address_purpose": "LOCATION",
            "city": "Lakeport",
            "state": "CA",
            "postal_code": "954534724",
            "country_code": "US",
            "telephone_number": "707-263-3116",
            "fax_number": "707-263-3117",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "320 1st St",
            "address_purpose": "LOCATION",
            "city": "Lakeport",
            "state": "CA",
            "postal_code": "95453",
            "country_code": "US",
            "telephone_number": "707-263-3116",
            "fax_number": "707-263-3117",
            "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": "2012-04-13",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-09",
        "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": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "276400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation, Substance Use Disorder Unit",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALOMS #",
            "identifier": "171721",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Dec 10, 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.