MEDICARE: SURPRISE VALLEY HEALTH CARE DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311Z00000X	Custodial Care Facility	230000025	CA
2	275N00000X	Medicare Defined Swing Bed Hospital Unit	230000025	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023194222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURPRISE VALLEY HEALTH CARE DISTRICT

Provider Business Mailing Address
First Line	:	PO BOX 246
Second Line	:
City	:	CEDARVILLE
State	:	CA
Zip	:	96104-0246
Country	:	US
Telephone Number	:	530-279-6111
Fax Number	:	530-279-2680

Provider Business Practice Location Address
First Line	:	741 NORTH MAIN ST
Second Line	:
City	:	CEDARVILLE
State	:	CA
Zip	:	96104-0246
Country	:	US
Telephone Number	:	530-279-6111
Fax Number	:	530-279-2680

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	RICHARD CORNWELL
Credential	:
Telephone Number	:	530-279-6111

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	02/07/2017

Similar Medicare Providers

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Practice Location Address:

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Practice Phone: 530-279-6111
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1073693651 — SURPRISE VALLEY HEALTH CARE DISTRICT
Practice Location Address:

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1700963956 — SURPRISE VALLEY HOSPITAL DISTRICT
Practice Location Address:

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1093843930 — DR. LENI KAREN SINCLAIR
Practice Location Address:

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1750829925 — PAFFORD HEALTH
Practice Location Address:

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1861022873 — CHUCK R. COLAS, D.O., P.C.
Practice Location Address:

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Directions to “SURPRISE VALLEY HEALTH CARE DISTRICT ” Practice Location

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