NPIMap

Organization Active NPI

Mission Provider Services, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Redding, CA
National Provider Identifier
1447306857
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
MISSION PROVIDER SERVICES, INC.
Practice address
3810 Canterbury Dr
Redding, CA 96002-4888
Phone
(530) 221-2236
Fax
(530) 222-5528
NPI assigned
Jan 26, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Dana Emerson
Title
Executive Director
Phone
(530) 222-5633

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X CA Primary

Addresses

Primary practice location

3810 Canterbury Dr
Redding, CA 96002-4888

Mailing address

2970 Innsbruck Dr Ste C
Redding, CA 96003-9303
Phone (530) 222-5633

Other identifiers 1

IdentifierTypeStateIssuer
55G306OtherCADHS ID NUMBER

National Provider Directory

National Provider Directory
Tax ID family
Mission Provider Services Inc11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

2970 Innsbruck Dr
Ste C
Redding, CA 96003
Phone (530) 222-5633

NPI Registry JSON

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1447306857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2970 INNSBRUCK DR STE C",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960039303",
            "telephone_number": "530-222-5633",
            "fax_number": "530-222-5528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3810 CANTERBURY DR",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960024888",
            "telephone_number": "530-221-2236",
            "fax_number": "530-222-5528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION PROVIDER SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EMERSON",
        "authorized_official_first_name": "DANA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "530-222-5633",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHS ID NUMBER",
            "identifier": "55G306",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Redding, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.