Provider Demographics
NPI:1679852958
Name:ADVENTIST HEALTH CALIFORNIA MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ADVENTIST HEALTH CALIFORNIA MEDICAL GROUP, INC.
Other - Org Name:ST. HELENA FAMILY HEALTH CENTER KELSEYVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPECIALIST, CONTRACT COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:KAYE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-968-2809
Mailing Address - Street 1:1001 ADAMS ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-1107
Mailing Address - Country:US
Mailing Address - Phone:707-968-2809
Mailing Address - Fax:707-963-9185
Practice Address - Street 1:5290 STATE ST
Practice Address - Street 2:
Practice Address - City:KELSEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95451-9450
Practice Address - Country:US
Practice Address - Phone:707-279-8813
Practice Address - Fax:707-279-2241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty