Healthcare Provider Details

I. General information

NPI: 1952487159
Provider Name (Legal Business Name): NORTH SONOMA COUNTY HEALTH CARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
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 Code314000000X
TaxonomySkilled Nursing Facility
License Number110000019
License Number StateCA

VIII. Authorized Official

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