Healthcare Provider Details

I. General information

NPI: 1609858950
Provider Name (Legal Business Name): ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 DOLBEER ST
EUREKA CA
95501
US

IV. Provider business mailing address

PO BOX 31001-3059
PASADENA CA
91110-3059
US

V. Phone/Fax

Practice location:
  • Phone: 707-445-8121
  • Fax: 707-269-3897
Mailing address:
  • Phone: 707-445-8121
  • Fax: 707-269-3897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number010000075
License Number StateCA

VIII. Authorized Official

Name: DONALD WAYNE ANDERSON JR.
Title or Position: ASSISTANT SECRETARY OF ENROLLMENTS
Credential:
Phone: 425-358-9786