Provider Demographics
NPI:1538113725
Name:ADVENTIST HEALTH MENDOCINO COAST
Entity Type:Organization
Organization Name:ADVENTIST HEALTH MENDOCINO COAST
Other - Org Name:MENDOCINO COAST DISTRICT HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
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 1:700 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-5403
Mailing Address - Country:US
Mailing Address - Phone:707-961-1234
Mailing Address - Fax:707-961-4901
Practice Address - Street 1:700 RIVER DR
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5403
Practice Address - Country:US
Practice Address - Phone:707-961-1234
Practice Address - Fax:707-961-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110000040282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ39861ZOtherBLUE SHIELD
LTC30569FOtherMEDICAL SWING BED
CAZZR00569FMedicaid
CAZZZ36026ZOtherBLUE SHIELD INFUSION
CAZZZ96931ZOtherBLUE SHIELD ER
CA952627981OtherCOMMERCIAL
PHB160620OtherBLUE SHIELD
MTE00312FOtherMEDICAL AMBULANCE
CAZZZ57360ZOtherBLUE SHIELD CLINIC
PHB160620OtherMEDICAL PHARMACY
HSP40569FOtherMEDICAL OUTPATIENT
CAZZZ14750ZOtherBLUE SHIELD
050569OtherBLUE CROSS
CAZZZA2301ZOtherBLUE SHIELD HOSPITAL
PHB160620OtherBLUE SHIELD
CA051325Medicare Oscar/Certification
CAZZZA2301ZOtherBLUE SHIELD HOSPITAL