Provider Demographics
NPI:1386164580
Name:REDDING RANCHERIA
Entity type:Organization
Organization Name:REDDING RANCHERIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-226-1740
Mailing Address - Street 1:1441 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0811
Mailing Address - Country:US
Mailing Address - Phone:530-224-2700
Mailing Address - Fax:530-224-2738
Practice Address - Street 1:81 ARBUCKLE COURT
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:CA
Practice Address - Zip Code:96093
Practice Address - Country:US
Practice Address - Phone:530-623-0021
Practice Address - Fax:530-623-0025
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REDDING RANCHERIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-20
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100267288Medicaid