Provider Demographics
NPI:1891214532
Name:ST HELENA HOSPITAL
Entity Type:Organization
Organization Name:ST HELENA HOSPITAL
Other - Org Name:BEHAVIORAL WELLNESS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:REGIONAL DIRECCTOR RISK
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:B
Authorized Official - Last Name:MEREDITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-963-6260
Mailing Address - Street 1:525 OREGON ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-3201
Mailing Address - Country:US
Mailing Address - Phone:707-648-2200
Mailing Address - Fax:
Practice Address - Street 1:183 BUTCHER RD STE B
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-5691
Practice Address - Country:US
Practice Address - Phone:707-648-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. HELENA HOSPITAL OR CENTER FOR BEHAVIORAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA261QM0850XOtherADULT MENTAL HEALTH