County of Siskiyou
Organization Active NPI Community/Behavioral Health Agency · Yreka, CA
NPI 1780803239 · NPPES record last updated May 3, 2024
Key facts
- NPI
- 1780803239
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Legal business name
- COUNTY OF SISKIYOU
- Practice address
- 2060 Campus Dr
Yreka, CA 96097-9538 - Phone
- (530) 841-4100
- Fax
- (530) 841-4230
- NPI assigned
- Apr 24, 2007
- Organization subpart
- No
Authorized official
- Name
- Rose Marie Bullock
- Title
- Administrative Services Manager
- Phone
- (530) 841-4732
Other NPIs on the same Medicare enrollment 1
Subparts reporting this organization as parent 1
Practitioners 12
-
Jeremy Goldsmith, LCSW
-
Rinnah Macvittie, FNP-BC; AGNP-C
-
Candace A Ross, MSW, LCSW, MAC, CCTP
-
David Lee Johnson, M.D.
-
Kellie Nicole Malewski, LMSW, CAADC
-
Erica Picon, LCSW
-
Elvia Amezcua, LCSW
-
John Lester Schaeffer, D.O.
-
Carrie Whiting, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20121207000287 | CA | Part B Supplier - Clinic/Group Practice | 8224280706 |
Receives reassigned benefits from 12 practitioners 1 other NPI on this enrollment Practice locations: Mount Shasta, CA; Yreka, CA |
National Provider Directory
Locations
1147 Hartnell Ave
Redding, CA 96002
Phone (530) 222-7213
201 Brush St
#201A
Ukiah, CA 95482
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Yes |
Addresses
Primary practice location
2060 Campus Dr
Yreka, CA 96097-9538
Mailing address
2060 Campus Dr
Yreka, CA 96097-9538
Phone (530) 841-4100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01114108 | Medicaid | CA |
Other names
- County of Siskiyou Behavioral Health
Other providers in Yreka, CA
- Kara Collier
- Heather Collins
- Paul Jerome Connelly
- Monica Michele Cooley
- County of Siskiyou
- Robert Charles Cowan
- Joshua Cox
- Craig W. Calhoun, MD, Prof. Corp.
- Crane Mountain LLC
- Elisabeth Cravens
All providers in Yreka, CA · Community/Behavioral Health Agency in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.