Provider Demographics
NPI:1073788832
Name:REDWOODS RURAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:REDWOODS RURAL HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:STAUNTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MPH
Authorized Official - Phone:707-923-2783
Mailing Address - Street 1:PO BOX 769
Mailing Address - Street 2:
Mailing Address - City:REDWAY
Mailing Address - State:CA
Mailing Address - Zip Code:95560-0769
Mailing Address - Country:US
Mailing Address - Phone:707-923-2783
Mailing Address - Fax:707-923-2543
Practice Address - Street 1:101 WEST COAST ROAD
Practice Address - Street 2:
Practice Address - City:REDWAY
Practice Address - State:CA
Practice Address - Zip Code:95560
Practice Address - Country:US
Practice Address - Phone:797-923-2783
Practice Address - Fax:707-923-2543
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REDWOODS RURAL HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-23
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110000099261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAP03891FMedicaid