Provider Demographics
NPI:1669102042
Name:CHILDREN'S LEGACY CENTER
Entity type:Organization
Organization Name:CHILDREN'S LEGACY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-232-0535
Mailing Address - Street 1:1095 HILLTOP DR # 369
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-3811
Mailing Address - Country:US
Mailing Address - Phone:530-768-7325
Mailing Address - Fax:
Practice Address - Street 1:1400 OREGON ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1620
Practice Address - Country:US
Practice Address - Phone:530-768-1880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S LEGACY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-16
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)