1538113725 NPI number — ADVENTIST HEALTH MENDOCINO COAST

Table of content: (NPI 1538113725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538113725 NPI number — ADVENTIST HEALTH MENDOCINO COAST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVENTIST HEALTH MENDOCINO COAST
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MENDOCINO COAST DISTRICT HOSPITAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538113725
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 RIVER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT BRAGG
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95437-5403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-961-1234
Provider Business Mailing Address Fax Number:
707-961-4901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 RIVER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT BRAGG
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95437-5403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-961-1234
Provider Business Practice Location Address Fax Number:
707-961-4901
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOWE
Authorized Official First Name:
JUDSON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
707-456-3010

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  110000040 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZZ39861Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: LTC30569F . This is a "MEDICAL SWING BED" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZR00569F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ36026Z . This is a "BLUE SHIELD INFUSION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ96931Z . This is a "BLUE SHIELD ER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 952627981 . This is a "COMMERCIAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: PHB160620 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: MTE00312F . This is a "MEDICAL AMBULANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ57360Z . This is a "BLUE SHIELD CLINIC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: PHB160620 . This is a "MEDICAL PHARMACY" identifier . This identifiers is of the category "OTHER".
  • Identifier: HSP40569F . This is a "MEDICAL OUTPATIENT" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZ14750Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 050569 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZA2301Z . This is a "BLUE SHIELD HOSPITAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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