Provider Demographics
NPI:1194824573
Name:NORTH SONOMA COUNTY HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:NORTH SONOMA COUNTY HEALTH CARE DISTRICT
Other - Org Name:HEALDSBURG DISTRICT HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:BALAND
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:707-239-9068
Mailing Address - Street 1:1375 UNIVERSITY AVE.
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3382
Mailing Address - Country:US
Mailing Address - Phone:707-431-6500
Mailing Address - Fax:707-431-6588
Practice Address - Street 1:1375 UNIVERSITY AVE.
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3382
Practice Address - Country:US
Practice Address - Phone:707-431-6500
Practice Address - Fax:707-431-6588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110000019282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP40331IMedicaid
CAZZR00331IMedicaid
CAZZR00331IMedicaid