Provider Demographics
NPI:1689665267
Name:ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI
Entity Type:Organization
Organization Name:ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI
Other - Org Name:ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI SWING BED
Other - Org Type:Other Name
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 1:1100 MAGELLAN DR
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-1380
Practice Address - Country:US
Practice Address - Phone:661-771-8600
Practice Address - Fax:661-771-8399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120000188282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC30446FMedicaid
CARHM13977FMedicaid
CAZZT40446FMedicaid
CARHM13979FMedicaid
CAZZT30446FMedicaid
CA05Z301Medicare Oscar/Certification
CAZZT30446FMedicaid
CARHM13977FMedicaid