Provider Demographics
NPI:1770624553
Name:OAK VALLEY HOSPITAL DISTRICT
Entity type:Organization
Organization Name:OAK VALLEY HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSKREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-848-4104
Mailing Address - Street 1:350 S OAK AVE
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3519
Mailing Address - Country:US
Mailing Address - Phone:209-847-3011
Mailing Address - Fax:209-848-7008
Practice Address - Street 1:2080 MCHENRY AVE # 100
Practice Address - Street 2:
Practice Address - City:ESCALON
Practice Address - State:CA
Practice Address - Zip Code:95320-9484
Practice Address - Country:US
Practice Address - Phone:209-847-3011
Practice Address - Fax:209-848-4110
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OAK VALLEY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-12
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA030000069261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM08606FMedicaid
CABCP08606FMedicaid
CAHAP08606FMedicaid
CA=========OtherTAX ID NUMBER
CA=========953610006OtherTRICARE
CABCP08606FMedicaid