Provider Demographics
NPI:1407637317
Name:WARDLE, CHRISTOPHER (HEALTH AMBASSADOR)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:WARDLE
Suffix:
Gender:M
Credentials:HEALTH AMBASSADOR
Other - Prefix:
Other - First Name:CHRISSY
Other - Middle Name:
Other - Last Name:WARDLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PUBLIC AUTHORITY
Mailing Address - Street 1:PO BOX 5081
Mailing Address - Street 2:
Mailing Address - City:SHASTA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:96089-5081
Mailing Address - Country:US
Mailing Address - Phone:530-238-7614
Mailing Address - Fax:
Practice Address - Street 1:1450 COURT ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1683
Practice Address - Country:US
Practice Address - Phone:530-238-7614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No172A00000XOther Service ProvidersDriver
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty