Provider Demographics
NPI:1003008368
Name:OSTERMAN'S #1 INC
Entity Type:Organization
Organization Name:OSTERMAN'S #1 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:OSTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-275-2346
Mailing Address - Street 1:PO BOX 905
Mailing Address - Street 2:
Mailing Address - City:SHASTA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:96019-0905
Mailing Address - Country:US
Mailing Address - Phone:530-275-2346
Mailing Address - Fax:530-275-6674
Practice Address - Street 1:1751 DAKOTA WAY
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-7501
Practice Address - Country:US
Practice Address - Phone:530-275-2346
Practice Address - Fax:530-275-6674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC 60766GOtherMEDI-CAL