Provider Demographics
NPI:1558702795
Name:REDWOOD COMMUNITY SERVICES, INC
Entity Type:Organization
Organization Name:REDWOOD COMMUNITY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PQI SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DONETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-467-2010
Mailing Address - Street 1:PO BOX 2077
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-2077
Mailing Address - Country:US
Mailing Address - Phone:707-467-2000
Mailing Address - Fax:707-467-2018
Practice Address - Street 1:631 S ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5011
Practice Address - Country:US
Practice Address - Phone:707-467-2010
Practice Address - Fax:707-467-2018
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REDWOOD COMMUNITY SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-16
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No251S00000XAgenciesCommunity/Behavioral Health
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA236803532OtherFFA FACILITY NUMBER