Provider Demographics
NPI:1073368502
Name:REDWOOD TEEN CHALLENGE
Entity type:Organization
Organization Name:REDWOOD TEEN CHALLENGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-268-8727
Mailing Address - Street 1:1435 7TH ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-0615
Mailing Address - Country:US
Mailing Address - Phone:707-268-8727
Mailing Address - Fax:
Practice Address - Street 1:2844 FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3525
Practice Address - Country:US
Practice Address - Phone:707-268-8727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging
No174200000XOther Service ProvidersMeals
No251B00000XAgenciesCase Management