Provider Demographics
NPI:1831724053
Name:REDDING RANCHERIA
Entity type:Organization
Organization Name:REDDING RANCHERIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TAMRA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-224-2700
Mailing Address - Street 1:4174 ASHBY CT
Mailing Address - Street 2:
Mailing Address - City:SHASTA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:96019-9215
Mailing Address - Country:US
Mailing Address - Phone:530-224-2700
Mailing Address - Fax:530-224-2738
Practice Address - Street 1:4174 ASHBY CT
Practice Address - Street 2:
Practice Address - City:SHASTA LAKE
Practice Address - State:CA
Practice Address - Zip Code:96019-9215
Practice Address - Country:US
Practice Address - Phone:530-224-2700
Practice Address - Fax:530-224-2738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)