Organization
MISSION PROVIDER SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANA EMERSON (EXECUTIVE DIRECTOR)
(530) 222-5633
Entity
Organization
Contact information
Practice address
1974 CIRRUS ST, REDDING, CA 96002-3330
(530) 224-1061
Mailing address
2970 INNSBRUCK DR STE C, REDDING, CA 96003-9303
(530) 222-5633
(530) 222-5528
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
230000332
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55G415
DHS ID NUMBER
CA
Enumeration date
01/25/2007
Last updated
07/25/2008
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