Provider Demographics
NPI:1033956412
Name:REDDING TRANSFORMATION DBA SHASTA THRIVE
Entity type:Organization
Organization Name:REDDING TRANSFORMATION DBA SHASTA THRIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECGTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-524-6880
Mailing Address - Street 1:PO BOX 493203
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-3203
Mailing Address - Country:US
Mailing Address - Phone:530-524-6880
Mailing Address - Fax:
Practice Address - Street 1:2174 PINE ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2635
Practice Address - Country:US
Practice Address - Phone:530-524-6880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty