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Organization
REDWOOD COMMUNITY SERVICES, INC
Active
Organization
REDWOOD COMMUNITY SERVICES, INC
Active
Other names
Redwood Community Services - Fort Bragg
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VICTORIA JERUSHA KELLY LCSW (CHIEF EXECUTIVE OFFICER)
(707) 467-2010
Entity
Organization
Contact information
Practice address
516 CYPRESS STREET, FORT BRAGG, CA 95437-5107
(707) 961-0308
(707) 961-0351
Mailing address
PO BOX 2077, 780 S. DORA STREET, UKIAH, CA 95482-2077
(707) 961-0308
(707) 961-0351
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
347C00000X
Private Vehicle
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23CO
MENDOCINO COUNTY SITE #
CA
Enumeration date
10/29/2013
Last updated
02/14/2023
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