Provider Demographics
NPI:1881684694
Name:ST. HELENA HOSPITAL
Entity Type:Organization
Organization Name:ST. HELENA HOSPITAL
Other - Org Name:ST HELENA HOSPITAL HOME CARE SERVICES IN LAKE COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-963-6217
Mailing Address - Street 1:PO BOX 6710
Mailing Address - Street 2:
Mailing Address - City:CLEARLAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95422-6710
Mailing Address - Country:US
Mailing Address - Phone:707-994-6486
Mailing Address - Fax:707-995-3631
Practice Address - Street 1:18TH AVE AND HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95422-6710
Practice Address - Country:US
Practice Address - Phone:707-994-0737
Practice Address - Fax:707-994-0745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA680395149 95422 0001OtherCHAMPUS
CAZZZ08766ZOtherBLUE SHIELD
CAHHA07710FMedicaid
CA680395149 95422 0001OtherCHAMPUS