1699084525 NPI number — ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699084525 NPI number — ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI
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:
ADVENTIST HEALTH COMMUNITY CARE - CALIFORNIA CITY
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:
1699084525
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 845755
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90084-5755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-771-8600
Provider Business Mailing Address Fax Number:
661-771-8399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9350 N LOOP BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALIFORNIA CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93505-2269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-823-1622
Provider Business Practice Location Address Fax Number:
661-823-1594
Provider Enumeration Date:
09/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
WOLCOTT
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
661-771-8600

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282NC0060X , with the licence number: 120000188 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: RHM13979F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZT30446F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: LTC30446F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: RHM08620F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZT40446F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: RHM13977F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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