Healthcare Provider Details

I. General information

NPI: 1124220249
Provider Name (Legal Business Name): ADVENTIST HEALTH MENDOCINO COAST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 RIVER DRIVE SUITE A
FORT BRAGG CA
95437
US

IV. Provider business mailing address

PO BOX 841941
LOS ANGELES CA
90084-1941
US

V. Phone/Fax

Practice location:
  • Phone: 707-961-4631
  • Fax: 707-964-1192
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PARKER PRIDGEN
Title or Position: PRESIDENT
Credential:
Phone: 707-456-3010