Provider Demographics
NPI:1235120676
Name:UKIAH ADVENTIST HOSPITAL
Entity Type:Organization
Organization Name:UKIAH ADVENTIST HOSPITAL
Other - Org Name:ADVENTIST HEALTH UKIAH VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUDSON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-456-3010
Mailing Address - Street 1:PO BOX 888867
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90088-8867
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:275 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4531
Practice Address - Country:US
Practice Address - Phone:707-463-7360
Practice Address - Fax:707-463-7689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207K00000X, 2085R0202X
CA110000095282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA195519900OtherUS DEPARTMENT OF LABOR
CAHSP40301FMedicaid
CAZZZ13334ZOtherBLUE SHIELD
CAZZZ92403ZOtherBLUE SHIELD
CA050301OtherBLUE CROSS
CA005433002OtherKAISER
CAZZZC2308ZOtherBLUE SHIELD
CAZZR00301FMedicaid
CAZZZC2307ZOtherBLUE SHIELD
CAZZZ18251ZOtherBLUE SHIELD
CAZZR00301FMedicaid
CA=========OtherBLUE CROSS
CAHSP40301FMedicaid
CAZZZ92403ZMedicare PIN