NPIMap

Organization Active NPI

Redwood Community Services, Inc.

  • Community/Behavioral Health Agency
  • Redwood Valley, CA
National Provider Identifier
1538445358
Registry record updated Jan 21, 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
7351 Sems LN
Redwood Valley, CA 95470
Phone
(707) 467-9192
Fax
(707) 467-9345
NPI assigned
Oct 25, 2011
Last updated
Jan 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2020

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

Authorized official

Name
Mrs. Victoria Jersuha Kelly, LCSWNPI 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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X NU
Community/Behavioral Health Agency 251S00000X CA Primary

Addresses

Primary practice location

7351 Sems LN
Redwood Valley, CA 95470

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
23CIOtherCAMENDOCINO COUNTY PROVIDER NUMBER

Other names 1

  • Madrone House 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
Tax ID family
Redwood Community Services29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

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

View all 28

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1319500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579564800000",
    "number": "1538445358",
    "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": "7351 SEMS LN",
            "city": "REDWOOD VALLEY",
            "state": "CA",
            "postal_code": "95470",
            "telephone_number": "707-467-9192",
            "fax_number": "707-467-9345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDWOOD COMMUNITY SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-25",
        "last_updated": "2020-01-21",
        "certification_date": "2020-01-21",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_middle_name": "JERSUHA",
        "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": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENDOCINO COUNTY PROVIDER NUMBER",
            "identifier": "23CI",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Madrone House",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Redwood Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 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.