Provider Demographics
NPI:1255543302
Name:BLOOD BANK OF THE REDWOODS
Entity type:Organization
Organization Name:BLOOD BANK OF THE REDWOODS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-545-1222
Mailing Address - Street 1:2324 BETHARDS DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-8537
Mailing Address - Country:US
Mailing Address - Phone:707-545-1222
Mailing Address - Fax:707-571-0152
Practice Address - Street 1:2324 BETHARDS DRIVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-8537
Practice Address - Country:US
Practice Address - Phone:707-545-1222
Practice Address - Fax:707-571-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9312331L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes331L00000XSuppliersBlood Bank
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABB0001970Medicaid