NPIMap

Organization Active NPI

Redwood Community Services, Inc.

  • Community/Behavioral Health Agency
  • Fort Bragg, CA
National Provider Identifier
1790054856
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
32670 Highway 20 Unit 2
Fort Bragg, CA 95437-5708
Phone
(707) 964-1136
Fax
(707) 964-4558
NPI assigned
Dec 19, 2011
Organization subpart
Yes
Parent organization
REDWOOD COMMUNITY SERVICES, INCAs reported in NPPES

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 Jerusha Kelly, LCSW
Title
Chief Executive Offcier
Phone
(707) 467-2010

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

32670 Highway 20 Unit 2
Fort Bragg, CA 95437-5708

Mailing address

PO Box 422
780 S. Dora St.
Ukiah, CA 95482-0422
Phone (707) 467-2010

Other identifiers 2

IdentifierTypeStateIssuer
23CJOtherCAMENDOCINO COUNTY PROVIDER NUMBER
67958OtherCACITY OF FORT BRAGG - BUISNESS LICENSE

Other names 1

  • RCS Behavioral Health Services Other name

National Provider Directory

National Provider Directory
Tax ID family
Redwood Community Services29 organizations share this tax ID, including this one
Part of
Redwood Community Services

Other organizations with this tax ID 28

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

View all 28

Locations

32670 Highway 20
Unit 2
Fort Bragg, CA 95437
Phone (707) 964-1136

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1324252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579564800000",
    "number": "1790054856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 422",
            "address_2": "780 S. DORA ST.",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954820422",
            "telephone_number": "707-467-2010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32670 HIGHWAY 20 UNIT 2",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954375708",
            "telephone_number": "707-964-1136",
            "fax_number": "707-964-4558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDWOOD COMMUNITY SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "REDWOOD COMMUNITY SERVICES, INC",
        "enumeration_date": "2011-12-19",
        "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": "JERUSHA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFCIER",
        "authorized_official_telephone_number": "707-467-2010",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENDOCINO COUNTY PROVIDER NUMBER",
            "identifier": "23CJ",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CITY OF FORT BRAGG - BUISNESS LICENSE",
            "identifier": "67958",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RCS Behavioral Health Services",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "RCS Behavioral Health Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fort Bragg, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.