Provider Demographics
NPI:1295810174
Name:SAN BENITO HEALTH FOUNDATION
Entity type:Organization
Organization Name:SAN BENITO HEALTH FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:VIVIAN
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:831-637-5306
Mailing Address - Street 1:351 FELICE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-3361
Mailing Address - Country:US
Mailing Address - Phone:831-637-5306
Mailing Address - Fax:831-637-9640
Practice Address - Street 1:351 FELICE DR
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-3361
Practice Address - Country:US
Practice Address - Phone:831-637-5306
Practice Address - Fax:831-637-9640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAP03872FMedicaid
CAEAP03872FOtherUNCOMPENSATED CARE
CABCP03872FMedicaid
CAFHC03872FOtherMEDI-CAL IDENTIFIER
CAHAP03872FMedicaid