Healthcare Provider Details

I. General information

NPI: 1023194222
Provider Name (Legal Business Name): SURPRISE VALLEY HEALTH CARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 NORTH MAIN ST
CEDARVILLE CA
96104-0246
US

IV. Provider business mailing address

PO BOX 246
CEDARVILLE CA
96104-0246
US

V. Phone/Fax

Practice location:
  • Phone: 530-279-6111
  • Fax: 530-279-2680
Mailing address:
  • Phone: 530-279-6111
  • Fax: 530-279-2680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number230000025
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number230000025
License Number StateCA

VIII. Authorized Official

Name: RICHARD CORNWELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 530-279-6111