NPIMap

Organization Active NPI

Shasta Community Health Center

Doing business as Shasta Community Health Center - Hope Van 2 - HOPE

  • Federally Qualified Health Center (FQHC)
  • Redding, CA
National Provider Identifier
1952328403
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
Shasta Community Health Center - Hope Van 2 - HOPE
Shasta Community Health Center - Mobile Unit 1
Practice address
1035 Placer St
Redding, CA 96001-1170
Phone
(530) 246-5710
Fax
(530) 241-7838
NPI assigned
Jul 17, 2006
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) 229-5074

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Dentist 122300000X 230000171 CA
Family Medicine Physician 207Q00000X 230000171 CA

Addresses

Primary practice location

1035 Placer St
Redding, CA 96001-1170

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
FHC70418FOtherCASCHC-HOPE MEDI-CAL NUMBER

Other names 2

  • Shasta Community Health Center - Hope Van 2 - HOPE Doing business as
  • Shasta Community Health Center - Mobile Unit 1 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
O20160127002562 CA Part A Provider - Federally Qualified Health Center (FQHC) 3870579816 Practice locations: Redding, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952328403. Details of each certification follow.

Federally qualified health center certification: CCN 751909

Legal name
SHASTA COMMUNITY HEALTH CENTER
Doing business as
HEALTH OUTREACH FOR PEOPLE EVERYWHERE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 8, 2016
Last certification
Jan 8, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1035 Placer St
Redding, CA 96001-1125

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.

National Provider Directory

National Provider Directory

Locations

4215 Front St
Shasta Lake, CA 96019
Phone (530) 246-5896

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Elizabeth Olson Individual Corporate DirectorConsumer Member Dec 15, 2022
Stephen Bell Individual Corporate DirectorConsumer Member Jan 28, 2021
Ray Hamby Individual Corporate DirectorConsumer Member Oct 15, 2007
Constantine Dean Germano Individual Corporate OfficerChief Executive Officer May 25, 1992
W-2 Managing EmployeeChief Executive Officer May 25, 1992
Mark Mitchelson Individual Corporate DirectorProvider Member Dec 14, 2020
Michael Mangas Individual Corporate DirectorConsumer Member Jul 25, 2019
Robert Folden Individual Corporate DirectorProvider Member Dec 13, 2021
Wendy Longwell Individual Corporate DirectorTreasurer Jun 25, 2017
John Kenny Individual Corporate DirectorVice Chair Apr 22, 2013
Samantha Breton Individual Corporate DirectorConsumer Member Oct 27, 2022
Kerry Fasking Individual Corporate DirectorChair Jul 23, 2013
Brandon Thornock Individual Corporate OfficerChief Operations Officer Oct 1, 2017
W-2 Managing EmployeeChief Operations Officer Oct 1, 2017
Margaret Beck Individual Corporate DirectorSecretary Feb 23, 2017
Dot Van Cleave Individual Corporate DirectorConsumer Member Sep 28, 2017
Amparo Beck Individual Corporate DirectorCommunity Member Feb 26, 2015

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729036800000",
    "number": "1952328403",
    "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",
            "fax_number": "530-241-7838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 PLACER ST",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960011170",
            "telephone_number": "530-246-5710",
            "fax_number": "530-241-7838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHASTA COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "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": "530-229-5074",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "230000171",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "230000171",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SCHC-HOPE MEDI-CAL NUMBER",
            "identifier": "FHC70418F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shasta Community Health Center - Hope Van 2 - HOPE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shasta Community Health Center - Mobile Unit 1",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Redding, CA

Sources for this page

Verify at the official NPI Registry.