Provider Demographics
NPI:1609222512
Name:ADVENTIST HEALTH CLEARLAKE HOSPITAL INC
Entity Type:Organization
Organization Name:ADVENTIST HEALTH CLEARLAKE HOSPITAL INC
Other - Org Name:ST. HELENA FAMILY HEALTH CENTER WILLIAMS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-995-5820
Mailing Address - Street 1:PO BOX 6710
Mailing Address - Street 2:
Mailing Address - City:CLEARLAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95422-6710
Mailing Address - Country:US
Mailing Address - Phone:707-995-5820
Mailing Address - Fax:
Practice Address - Street 1:501 E ST
Practice Address - Street 2:
Practice Address - City:WILLIAMS
Practice Address - State:CA
Practice Address - Zip Code:95987-5810
Practice Address - Country:US
Practice Address - Phone:530-473-5641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110000174261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health