Organization
SHASTA COMMUNITY HEALTH CENTER
Active
Organization
SHASTA COMMUNITY HEALTH CENTER
Active
Other names
Juvenile Hall
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFERY BRANDON THORNOCK (CEO)
(530) 246-5710
Entity
Organization
Contact information
Practice address
2684 RADIO LN, REDDING, CA 96001-4232
(530) 246-5710
Mailing address
PO BOX 992790, REDDING, CA 96099-2790
(530) 246-5779
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
207QA0000X
Adolescent Medicine (Family Medicine) Physician
—
—
208000000X
Pediatrics Physician
—
—
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
06/08/2022
Last updated
10/16/2024
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