Provider Demographics
NPI:1467668616
Name:COUNTY OF TEHAMA
Entity Type:Organization
Organization Name:COUNTY OF TEHAMA
Other - Org Name:TEHAMA COUNTY HEALTH SERVICES AGENCY
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LUCERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-528-3269
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-0400
Mailing Address - Country:US
Mailing Address - Phone:530-527-8491
Mailing Address - Fax:530-527-0240
Practice Address - Street 1:1860 WALNUT STREET, SUITE A, B, D AND J
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080
Practice Address - Country:US
Practice Address - Phone:530-527-8491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEHAMA COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-15
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000005201Medicaid
ZZZ41643ZMedicare ID - Type Unspecified