Provider Demographics
NPI:1215382973
Name:SONOMA VALLEY HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:SONOMA VALLEY HEALTH CARE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-935-5000
Mailing Address - Street 1:347 ANDRIEUX ST
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6811
Mailing Address - Country:US
Mailing Address - Phone:707-935-5000
Mailing Address - Fax:
Practice Address - Street 1:270 PERKINS ST
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6955
Practice Address - Country:US
Practice Address - Phone:707-938-3131
Practice Address - Fax:707-938-3678
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SONOMA VALLEY HEALTH CARE DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-02
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208600000X
CA110000072282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA050090Medicare PIN