Provider Demographics
NPI:1649721077
Name:COUNTY OF SHASTA
Entity type:Organization
Organization Name:COUNTY OF SHASTA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MENTAL HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:DONNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:EWERT
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:530-245-6750
Mailing Address - Street 1:2640 BRESLAUER WAY
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-4246
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1612 MARKET ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1021
Practice Address - Country:US
Practice Address - Phone:530-225-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SHASTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-20
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health