Healthcare Provider Details

I. General information

NPI: 1255402921
Provider Name (Legal Business Name): ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 TRANCAS ST
NAPA CA
94558
US

IV. Provider business mailing address

1000 TRANCAS ST
NAPA CA
94558-2906
US

V. Phone/Fax

Practice location:
  • Phone: 707-252-4411
  • Fax: 707-257-4113
Mailing address:
  • Phone: 707-252-4411
  • Fax: 707-257-4113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number110000060
License Number StateCA

VIII. Authorized Official

Name: DONALD WAYNE ANDERSON JR.
Title or Position: DIRECTOR-REIMBURSEMENT ADMINISTRATI
Credential:
Phone: 425-525-5392