Provider Demographics
NPI:1851614523
Name:PALM DRIVE HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:PALM DRIVE HEALTH CARE DISTRICT
Other - Org Name:DEPARTMENT OF EMERGENCY ROOM
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF BUSINESS OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-829-4347
Mailing Address - Street 1:501 PETALUMA AVE
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4215
Mailing Address - Country:US
Mailing Address - Phone:707-823-8511
Mailing Address - Fax:
Practice Address - Street 1:501 PETALUMA AVE
Practice Address - Street 2:DEPARTMENT OF ER
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4215
Practice Address - Country:US
Practice Address - Phone:707-829-4373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110000091282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital