Provider Demographics
NPI:1669860201
Name:NORTH VALLEY DEVELOPMENTAL SERVICES INC.
Entity Type:Organization
Organization Name:NORTH VALLEY DEVELOPMENTAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-230-9540
Mailing Address - Street 1:2970 INNSBRUCK DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-9357
Mailing Address - Country:US
Mailing Address - Phone:530-222-5633
Mailing Address - Fax:
Practice Address - Street 1:1916 HERBSCENTA LN
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-1135
Practice Address - Country:US
Practice Address - Phone:530-222-5633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities