Provider Demographics
NPI:1790054856
Name:REDWOOD COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:REDWOOD COMMUNITY SERVICES, INC.
Other - Org Name:RCS BEHAVIORAL HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFCIER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:JERUSHA
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:707-467-2010
Mailing Address - Street 1:PO BOX 422
Mailing Address - Street 2:780 S. DORA ST.
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-0422
Mailing Address - Country:US
Mailing Address - Phone:707-467-2010
Mailing Address - Fax:
Practice Address - Street 1:32670 HIGHWAY 20 UNIT 2
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5708
Practice Address - Country:US
Practice Address - Phone:707-964-1136
Practice Address - Fax:707-964-4558
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REDWOOD COMMUNITY SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-19
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA23CJOtherMENDOCINO COUNTY PROVIDER NUMBER
CA67958OtherCITY OF FORT BRAGG - BUISNESS LICENSE