NPIMap

Organization Active NPI

Shasta Community Health Center

Doing business as Enterprise Family Health & Dental Center

  • Federally Qualified Health Center (FQHC)
  • Redding, CA
National Provider Identifier
1669004123
Registry record updated Oct 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SHASTA COMMUNITY HEALTH CENTER
Doing business as
Enterprise Family Health & Dental Center
Practice address
1201 Industrial St
Redding, CA 96002-0757
Phone
(530) 246-5710
NPI assigned
Feb 12, 2020
Last updated
Oct 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2024

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

Authorized official

Name
Mr. Jeffery Brandon Thornock
Title
Ceo
Phone
(530) 246-5074

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Clinical Social Worker 1041C0700X
Optometrist 152W00000X
Specialist 174400000X
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X
Ophthalmology Physician 207W00000X
Psychiatry Physician 2084P0800X
Child & Adolescent Psychiatry Physician 2084P0804X

Addresses

Primary practice location

1201 Industrial St
Redding, CA 96002-0757

Mailing address

PO Box 992790
Redding, CA 96099-2790
Phone (530) 246-5710

Other names 1

  • Enterprise Family Health & Dental Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040629000721 CA Part B Supplier - Clinic/Group Practice 3870579816 Receives reassigned benefits from 156 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Anderson, CA; Redding, CA; Shasta Lake, CA
O20200513001426 CA Part A Provider - Federally Qualified Health Center (FQHC) 3870579816 Practice locations: Redding, CA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1669004123. Details of each certification follow.

Federally qualified health center certification: CCN 921881

Legal name
SHASTA COMMUNITY HEALTH CENTER
Doing business as
ENTERPRISE FAMILY HEALTH AND DENTAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 12, 2020
Last certification
Apr 12, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1201 Industrial St
Redding, CA 96002-0757

Federally qualified health center certification: CCN A01017

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CENTER OF HOPE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 18, 2021
Last certification
Aug 18, 2021
Ownership / control type
For profit – corporation
Facility address
1201 Industrial St
Redding, CA 96002

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 6

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

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
05D2290197Enterprise Family Health and Dental Care1201 Industrial Street, Redding, CA 96002Certificate of waiverSep 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
Shasta Community HLTH Ctr7 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.

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Laura Baynard Individual Corporate OfficerChief Operations Officer Mar 3, 2024
W-2 Managing EmployeeChief Operations Officer Mar 3, 2024
Stephen Bell Individual Corporate DirectorConsumer Member Jan 24, 2024
Christy Coleman Individual Corporate DirectorCommunity Member Apr 27, 2023
Alicia Torge Individual Corporate DirectorProvider Member Sep 25, 2025
Daniel Santi Individual Corporate OfficerChief Financial Officer Aug 24, 2023
W-2 Managing EmployeeChief Financial Officer Aug 24, 2023
Michael Mangas Individual Corporate DirectorConsumer Member Jul 25, 2019
Robert Folden Individual Corporate DirectorProvider Dec 13, 2021
Brian Bradley Individual Corporate DirectorCommunity Member Nov 14, 2024
Wendy Longwell Individual Corporate DirectorTreasurer Jun 25, 2014
Anastasiia Borysiuk Individual Corporate DirectorConsumer Member Mar 28, 2024
John Kenny Individual Corporate DirectorVice Chair Apr 22, 2013
Samantha Breton Individual Corporate DirectorConsumer Member Oct 27, 2022
Lawrence Vogt Individual Corporate Director Jun 27, 2024
Kerry Fasking Individual Corporate DirectorChair Jul 24, 2013
Brandon Thornock Individual Corporate OfficerChief Executive Officer Oct 1, 2017
W-2 Managing EmployeeChief Executive Officer Oct 1, 2017
Margaret Beck Individual Corporate DirectorSecretary Feb 23, 2017
Dot Van Cleave Individual Corporate DirectorConsumer Member Sep 28, 2017

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1581465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729036800000",
    "number": "1669004123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 992790",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960992790",
            "telephone_number": "530-246-5710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 INDUSTRIAL ST",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960020757",
            "telephone_number": "530-246-5710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHASTA COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-12",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A",
        "authorized_official_last_name": "THORNOCK",
        "authorized_official_first_name": "JEFFERY",
        "authorized_official_middle_name": "BRANDON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "530-246-5074",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Enterprise Family Health & Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Redding, CA

Sources for this page

Verify at the official NPI Registry.