Provider Demographics
NPI:1275841629
Name:ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI
Entity Type:Organization
Organization Name:ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI
Other - Org Name:ADVENTIST HEALTH COMMUNITY CARE - TEHACHAPI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-771-8600
Mailing Address - Street 1:PO BOX 845755
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-5755
Mailing Address - Country:US
Mailing Address - Phone:661-771-8600
Mailing Address - Fax:661-771-8399
Practice Address - Street 1:105 W E ST
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-1607
Practice Address - Country:US
Practice Address - Phone:661-823-1622
Practice Address - Fax:661-823-1594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
CA120000188282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM13979FMedicaid
CAZZT30446Medicaid
CAZZT40446FMedicaid
CARHM08620FMedicaid
CALTC30446FMedicaid
CARHM13977FMedicaid
CAZZT40446FMedicaid
CALTC30446FMedicaid
CAZZT30446Medicaid
CARHM13979FMedicaid
CA05Z301Medicare Oscar/Certification
553977Medicare PIN
CARHM13977FMedicaid