Provider Demographics
NPI:1518996040
Name:AMERICAN HOSPITAL MANAGEMENT CORPORATION
Entity Type:Organization
Organization Name:AMERICAN HOSPITAL MANAGEMENT CORPORATION
Other - Org Name:MAD RIVER COMMUNITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-822-7220
Mailing Address - Street 1:PO BOX 1115
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95518-1115
Mailing Address - Country:US
Mailing Address - Phone:707-822-3621
Mailing Address - Fax:707-826-8258
Practice Address - Street 1:3800 JANES RD
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4742
Practice Address - Country:US
Practice Address - Phone:707-822-3621
Practice Address - Fax:707-826-8258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110000031282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP40028FMedicaid
CAZZZC1209ZOtherBLUE SHIELD PROVIDER #
CAZZR00028FMedicaid
CA05-0028OtherBLUE CROSS PROVIDER #
CA05U028OtherMEDICARE SWING BED #
CAHST00028FOtherMEDI-CAL SWING BED #
CAHST00028FOtherMEDI-CAL SWING BED #