Provider Demographics
NPI:1154571636
Name:ADVENTIST HEALTH CALIFORNIA MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:ADVENTIST HEALTH CALIFORNIA MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAYE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-968-2809
Mailing Address - Street 1:10 WOODLAND RD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-9554
Mailing Address - Country:US
Mailing Address - Phone:707-963-1882
Mailing Address - Fax:707-963-1895
Practice Address - Street 1:18990 COYOTE VALLEY ROAD
Practice Address - Street 2:SUITE 8
Practice Address - City:HIDDEN VALLEY LAKE
Practice Address - State:CA
Practice Address - Zip Code:95467
Practice Address - Country:US
Practice Address - Phone:707-987-8344
Practice Address - Fax:707-987-8395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG882012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty