Healthcare Provider Details

I. General information

NPI: 1912455544
Provider Name (Legal Business Name): NORTH SONOMA COUNTY HEALTHCXARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 UNIVERSITY ST
HEALDSBURG CA
95448-3382
US

IV. Provider business mailing address

1375 UNIVERSITY ST
HEALDSBURG CA
95448-3382
US

V. Phone/Fax

Practice location:
  • Phone: 707-431-6500
  • Fax: 707-431-6588
Mailing address:
  • Phone: 707-431-6500
  • Fax: 707-431-6588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICHARD RAY BALAND
Title or Position: CFO
Credential: CPA
Phone: 707-239-9068