Provider Demographics
NPI:1104151844
Name:NORTHBAY HEALTHCARE GROUP
Entity type:Organization
Organization Name:NORTHBAY HEALTHCARE GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT ADMINSTRATIVE SERV
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:E
Authorized Official - Last Name:WALBOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-646-4196
Mailing Address - Street 1:1000 NUT TREE RD
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-4100
Mailing Address - Country:US
Mailing Address - Phone:707-646-4193
Mailing Address - Fax:707-399-2651
Practice Address - Street 1:1000 NUT TREE RD
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-4100
Practice Address - Country:US
Practice Address - Phone:707-646-4193
Practice Address - Fax:707-399-2651
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHBAY HEALTHCARE GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110000093282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110000093OtherDHS LICENSE