Provider Demographics
NPI:1093732554
Name:REEDLEY COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:REEDLEY COMMUNITY HOSPITAL
Other - Org Name:ADVENTIST HEALTH REEDLEY - FOWLER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CENTRAL VALLEY NETWORK PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOFL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-537-0056
Mailing Address - Street 1:PO BOX 888806
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90088-8806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 S LEON S PETERS BLVD
Practice Address - Street 2:
Practice Address - City:FOWLER
Practice Address - State:CA
Practice Address - Zip Code:93625-2439
Practice Address - Country:US
Practice Address - Phone:559-834-1614
Practice Address - Fax:559-834-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040000140261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM08595GMedicaid
CARHM08595GMedicaid