Provider Demographics
NPI:1265022503
Name:OPEN LINE - THE OAKS
Entity Type:Organization
Organization Name:OPEN LINE - THE OAKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-246-7172
Mailing Address - Street 1:PO BOX 992197
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-2197
Mailing Address - Country:US
Mailing Address - Phone:530-246-7172
Mailing Address - Fax:
Practice Address - Street 1:4678 ALTA MESA DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-3720
Practice Address - Country:US
Practice Address - Phone:530-223-2673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPEN LINE GROUP HOMES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty