Provider Demographics
NPI:1144389941
Name:STANFORD HEALTH CARE TRI-VALLEY
Entity Type:Organization
Organization Name:STANFORD HEALTH CARE TRI-VALLEY
Other - Org Name:THE HOSPITAL COMMITTEE FOR THE VALLEY MEMORIAL
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WICHELMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-847-3000
Mailing Address - Street 1:PO BOX 748618
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-8618
Mailing Address - Country:US
Mailing Address - Phone:925-847-3000
Mailing Address - Fax:
Practice Address - Street 1:5555 W LAS POSITAS BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-4000
Practice Address - Country:US
Practice Address - Phone:925-847-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000114282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP40283FMedicaid
CAZZR00283FMedicaid
CA050283Medicare Oscar/Certification