Provider Demographics
NPI:1801063870
Name:ADVENTIST HEALTH HOME CARE SERVICES OF REDBUD
Entity type:Organization
Organization Name:ADVENTIST HEALTH HOME CARE SERVICES OF REDBUD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT VP FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SWENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-995-5811
Mailing Address - Street 1:9254 HWY 53
Mailing Address - Street 2:
Mailing Address - City:LOWER LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95457
Mailing Address - Country:US
Mailing Address - Phone:707-994-0737
Mailing Address - Fax:707-994-0745
Practice Address - Street 1:9245 HWY 53
Practice Address - Street 2:
Practice Address - City:LOWER LAKE
Practice Address - State:CA
Practice Address - Zip Code:95457
Practice Address - Country:US
Practice Address - Phone:707-994-6486
Practice Address - Fax:707-995-1407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110000174251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA07710FMedicaid
CA=========OtherTAX ID #
CA=========OtherTAX ID #