Provider Demographics
NPI:1770653362
Name:UKIAH ADVENTIST HOSPITAL
Entity Type:Organization
Organization Name:UKIAH ADVENTIST HOSPITAL
Other - Org Name:ADVENTIST HEALTH UKIAH VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
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:PO BOX 888867
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90088-8867
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1050 N STATE ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-3414
Practice Address - Country:US
Practice Address - Phone:707-463-8000
Practice Address - Fax:707-462-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110000095261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP40301FMedicaid
CA058626Medicare Oscar/Certification
CAHSP40301FMedicaid