Provider Demographics
NPI:1720088354
Name:RIDEOUT MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:RIDEOUT MEMORIAL HOSPITAL
Other - Org Name:ADVENTIST HEALTH AND RIDEOUT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:HEIDAR
Authorized Official - Middle Name:
Authorized Official - Last Name:THORDARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-751-4049
Mailing Address - Street 1:726 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-5656
Mailing Address - Country:US
Mailing Address - Phone:530-749-4300
Mailing Address - Fax:
Practice Address - Street 1:726 4TH ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5656
Practice Address - Country:US
Practice Address - Phone:530-749-4300
Practice Address - Fax:530-749-4375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000126282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR00133FMedicaid
CAGNMW00150Medicaid
CAZZR00133FMedicaid
CA050133Medicare Oscar/Certification