MEDICARE: AMERICAN HOSPITAL MANAGEMENT CORPORATION

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	251E00000X	Home Health Agency	010000166	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
2	057524	OTHER	CA	BLUE CROSS OF CALIFORNIA
3	ZZZ97638Z	OTHER	CA	BLUE SHIELD OF CALIFORNIA

General Provider Information

NPI Number	:	1750305371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN HOSPITAL MANAGEMENT CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 1115
Second Line	:
City	:	ARCATA
State	:	CA
Zip	:	95518-1115
Country	:	US
Telephone Number	:	707-826-8420
Fax Number	:	707-826-8428

Provider Business Practice Location Address
First Line	:	4605 VALLEY WEST BLVD
Second Line	:
City	:	ARCATA
State	:	CA
Zip	:	95521-4635
Country	:	US
Telephone Number	:	707-826-8420
Fax Number	:	707-826-8428

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DOUGLAS ALLEN SHAW
Credential	:
Telephone Number	:	707-822-7220

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	09/20/2019

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Directions to “AMERICAN HOSPITAL MANAGEMENT CORPORATION ” Practice Location

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