Provider Demographics
NPI:1972212967
Name:SHASTA MEADOWS WELLNESS CENTER
Entity Type:Organization
Organization Name:SHASTA MEADOWS WELLNESS CENTER
Other - Org Name:SHASTA MEADOWS WELLNESS CENTER PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:TAGGART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-215-3820
Mailing Address - Street 1:1555 EAST ST STE 210
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1153
Mailing Address - Country:US
Mailing Address - Phone:415-713-6654
Mailing Address - Fax:
Practice Address - Street 1:1555 EAST ST STE 210
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1153
Practice Address - Country:US
Practice Address - Phone:530-215-3820
Practice Address - Fax:530-215-3745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-17
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty