Organization
SHASTA NUTRITION SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN MERL DICKINSON (OWNER)
(530) 355-5820
Entity
Organization
Contact information
Practice address
9225 PLACER RD, REDDING, CA 96001-2364
(530) 355-5820
Mailing address
PO BOX 993503, REDDING, CA 96099-3503
(530) 355-5820
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
—
—
Other
Enumeration date
11/15/2006
Last updated
08/22/2020
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