Provider Demographics
NPI:1679951982
Name:SHASTA HEARING AIDS
Entity type:Organization
Organization Name:SHASTA HEARING AIDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KOSSOL
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:530-515-5537
Mailing Address - Street 1:2070 CHURN CREEK RD STE A
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0748
Mailing Address - Country:US
Mailing Address - Phone:307-685-1101
Mailing Address - Fax:
Practice Address - Street 1:2070 CHURN CREEK RD STE A
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0748
Practice Address - Country:US
Practice Address - Phone:530-768-1101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist