Provider Demographics
NPI:1285921007
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:SPECIALIST, CONTRACT COMPLIANCE
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 1:1001 ADAMS ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-1107
Mailing Address - Country:US
Mailing Address - Phone:707-968-2809
Mailing Address - Fax:707-963-9185
Practice Address - Street 1:10 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-9554
Practice Address - Country:US
Practice Address - Phone:800-454-4673
Practice Address - Fax:707-967-5627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty