Provider Demographics
NPI:1710063870
Name:SONOMA VALLEY HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:SONOMA VALLEY HEALTH CARE DISTRICT
Other - Org Name:SONOMA VALLEY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-935-5000
Mailing Address - Street 1:347 ANDRIEUX ST
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6811
Mailing Address - Country:US
Mailing Address - Phone:707-935-5000
Mailing Address - Fax:
Practice Address - Street 1:347 ANDRIEUX ST
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6811
Practice Address - Country:US
Practice Address - Phone:707-935-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110000072282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR00090FMedicaid
CACGP168423Medicaid
CAHAP53855FMedicaid
CAHSP40090FMedicaid
CAHSP40090FMedicaid