Provider Demographics
NPI:1265567622
Name:COUNTY OF SHASTA THROUGH HEALTH & HUMAN SERVICES AGENCY
Entity type:Organization
Organization Name:COUNTY OF SHASTA THROUGH HEALTH & HUMAN SERVICES AGENCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REDDING CCS MTU THERAPIST SUPERVISO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:TRIANTAFYLLOU
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:530-225-5574
Mailing Address - Street 1:2750 WIXON LANE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001
Mailing Address - Country:US
Mailing Address - Phone:530-225-5574
Mailing Address - Fax:530-225-5563
Practice Address - Street 1:2750 WIXON LANE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-225-5574
Practice Address - Fax:530-225-5563
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SHASTA THROUGH HHSA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-23
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACCS00014FOtherMEDICAL