1952487159 NPI number — NORTH SONOMA COUNTY HEALTH CARE DISTRICT

Table of content: (NPI 1952487159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952487159 NPI number — NORTH SONOMA COUNTY HEALTH CARE DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH SONOMA COUNTY HEALTH CARE DISTRICT
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:
HEALDSBURG 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:
1952487159
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1375 UNIVERSITY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEALDSBURG
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95448-3382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-431-6500
Provider Business Mailing Address Fax Number:
707-431-6588

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1375 UNIVERSITY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEALDSBURG
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95448-3382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-431-6500
Provider Business Practice Location Address Fax Number:
707-431-6588
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BALAND
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
707-239-9068

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  110000019 , 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: LTC70147F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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