1720078082 NPI number — ST. HELENA HOSPITAL

Table of content: (NPI 1720078082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720078082 NPI number — ST. HELENA HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. HELENA HOSPITAL
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:
Provider Other Organization Name Type Code:
6
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:
1720078082
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 WOODLAND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT HELENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94574-9554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-963-3611
Provider Business Mailing Address Fax Number:
707-963-6461

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 WOODLAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT HELENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94574-9554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-963-3611
Provider Business Practice Location Address Fax Number:
707-963-6461
Provider Enumeration Date:
10/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HERBER
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
707-963-3611

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZZZ06118Z . This is a "BLUE SHIELD OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CD7267 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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