Provider Demographics
NPI:1255483202
Name:NORTHBAY HEALTHCARE GROUP
Entity Type:Organization
Organization Name:NORTHBAY HEALTHCARE GROUP
Other - Org Name:NORTHBAY VACAVALLEY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR DIRECTOR, REVENUE CYCLE MGMT
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:EICHENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-646-3400
Mailing Address - Street 1:1000 NUT TREE RD
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-4100
Mailing Address - Country:US
Mailing Address - Phone:707-646-3401
Mailing Address - Fax:707-646-4803
Practice Address - Street 1:1000 NUT TREE RD
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-4100
Practice Address - Country:US
Practice Address - Phone:707-646-3401
Practice Address - Fax:707-646-4803
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHBAY HEALTHCARE GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-18
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110000093282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP40680FOtherMEDI-CAL (OUTPATIENT)
CAHSP30680FOtherMEDI-CAL (INPATIENT)
CA110000093OtherDHS LICENSE
CAHSP30680FOtherMEDI-CAL (INPATIENT)