NPIMap

Organization Active NPI

Department of Veterans Affairs of the State of California

Doing business as Veterans Home of California - Redding

  • Skilled Nursing Facility
  • Redding, CA
National Provider Identifier
1396165353
Registry record updated Jul 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
550002715 Issued in CA
Legal business name
DEPARTMENT OF VETERANS AFFAIRS OF THE STATE OF CALIFORNIA
Doing business as
Veterans Home of California - Redding
Practice address
3400 Knighton Rd
Redding, CA 96002-9498
Phone
(530) 224-3429
Fax
(530) 222-7599
NPI assigned
Apr 17, 2014
Last updated
Jul 11, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2016

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

Authorized official

Name
Mr. Timothy Bouseman
Title
Administrator
Phone
(530) 224-3300

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 455002486 CA
Skilled Nursing Facility 314000000X 550002715 CA Primary

Addresses

Primary practice location

3400 Knighton Rd
Redding, CA 96002-9498

Mailing address

PO Box 942895
Sacramento, CA 94295-0001
Phone (916) 657-9349

Other names 1

  • Veterans Home of California - Redding Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140925002244 CA Part A Provider - Skilled Nursing Facility 6507099520 Practice locations: Redding, CA
O20150818004043 CA Part B Supplier - Clinic/Group Practice 6507099520 Receives reassigned benefits from 21 practitioners
2 other NPIs on this enrollment
Practice locations: Fresno, CA; Los Angeles, CA; Redding, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396165353. Details of each certification follow.

Skilled nursing facility certification: CCN 555891

Legal name
DEPARTMENT OF VETERANS AFFAIRS OF THE STATE OF CALIFORNIA
Doing business as
VETERANS HOME OF CALIFORNIA REDDING
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 29, 2015
Last certification
Apr 10, 2025
Beds
60
Ownership / control type
State
Multi-facility organization
California Department of Veterans Affairs
Organization structure
GovernmentNon-profit
Enrollment address
3400 Knighton Rd
Redding, CA 96002-9498
Nursing home name
VETERANS HOME OF CALIFORNIA - REDDING

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Veterans Home Of California - ReddingCCN 555891 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
Government - State
Certified
Apr 29, 2015
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6039.9 residents per day on average
Penalties (3 years)
1Fines totaling $8,278

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2077008California Veterans Home Redding3400 Knighton Road, Redding, CA 96002Provider-performed microscopyDec 9, 2026

National Provider Directory

National Provider Directory
Tax ID family
Veterans Home of Ca Ventura7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

3400 Knighton Rd
Redding, CA 96002
Phone (530) 224-3429

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Timothy Kreisher Individual Operational/Managerial Control Nov 22, 2024
Adp of the SNF Nov 22, 2024
Jessica Koppes Individual Operational/Managerial Control May 23, 2025
Adp of the SNF May 23, 2025
James B Vogus Individual Operational/Managerial Control Jul 1, 2012
Adp of the SNF Jul 1, 2012
Department of Veterans Affairs of the State of California Organization, Redding, CA Medical provider/supplier 5% Or Greater Direct Ownership Interest Oct 22, 2013 100%
Operational/Managerial Control Oct 22, 2013
Adp of the SNF Oct 22, 2013

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Veterans Home of California - FresnoFresno, CA, CCN 555900 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 Oct 13, 2013
Oct 13, 2013
Oct 13, 2013
Veterans Home of California - West laLos Angeles, CA, CCN 555917 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Oct 3, 2010
Jun 1, 2018

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 23

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 23

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1397692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468195200000",
    "number": "1396165353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 942895",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "942950001",
            "telephone_number": "916-657-9349",
            "fax_number": "916-653-1795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 KNIGHTON RD",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960029498",
            "telephone_number": "530-224-3429",
            "fax_number": "530-222-7599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPARTMENT OF VETERANS AFFAIRS OF THE STATE OF CALIFORNIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-17",
        "last_updated": "2016-07-11",
        "status": "A",
        "authorized_official_last_name": "BOUSEMAN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "530-224-3300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "455002486",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "550002715",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Veterans Home of California - Redding",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Redding, CA

Sources for this page

Verify at the official NPI Registry.