NPIMap

Organization Active NPI

County of Siskiyou

Doing business as County of Siskiyou Behavioral Health Services

  • Community/Behavioral Health Agency
  • Mount Shasta, CA
National Provider Identifier
1427219237
Registry record updated Sep 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
COUNTY OF SISKIYOU
Doing business as
County of Siskiyou Behavioral Health Services
Practice address
1107 Ream Ave
Mount Shasta, CA 96067-9768
Phone
(530) 918-7200
Fax
(530) 918-7216
NPI assigned
Jun 24, 2008
Last updated
Sep 23, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
COUNTY OF SISKIYOU BEHAVIORAL HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 23, 2024

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

Authorized official

Name
Rose Marie Bullock
Title
Administrative Services Manager
Phone
(530) 841-4732

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X CA Primary

Addresses

Primary practice location

1107 Ream Ave
Mount Shasta, CA 96067-9768

Mailing address

1107 Ream Ave
Mt. Shasta, CA 96067
Phone (530) 918-7200

Other names 1

  • County of Siskiyou Behavioral Health Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121207000287 CA Part B Supplier - Clinic/Group Practice 8224280706 Receives reassigned benefits from 12 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mount Shasta, CA; Yreka, CA

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
Siskiyou County Behav H

Locations

1107 Ream Ave
Mount Shasta, CA 96067
Phone (530) 918-7200

427 Alder St
Mount Shasta, CA 96067
Phone (530) 841-4734

2060 Campus Dr
Yreka, CA 96097
Phone (530) 841-4100

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

NPI Registry JSON

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

{
    "created_epoch": "1214265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727049600000",
    "number": "1427219237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 REAM AVE",
            "city": "MT. SHASTA",
            "state": "CA",
            "postal_code": "96067",
            "telephone_number": "530-918-7200",
            "fax_number": "530-918-7216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 REAM AVE",
            "city": "MOUNT SHASTA",
            "state": "CA",
            "postal_code": "960679768",
            "telephone_number": "530-918-7200",
            "fax_number": "530-918-7216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF SISKIYOU",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF SISKIYOU BEHAVIORAL HEALTH",
        "enumeration_date": "2008-06-24",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "ROSE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "ADMINISTRATIVE SERVICES MANAGER",
        "authorized_official_telephone_number": "530-841-4732"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "County of Siskiyou Behavioral Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Shasta, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; 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.