Healthcare Provider Details

I. General information

NPI: 1235120676
Provider Name (Legal Business Name): UKIAH ADVENTIST HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 07/17/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 HOSPITAL DR
UKIAH CA
95482-4531
US

IV. Provider business mailing address

PO BOX 888867
LOS ANGELES CA
90088-8867
US

V. Phone/Fax

Practice location:
  • Phone: 707-463-7360
  • Fax: 707-463-7689
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number110000095
License Number StateCA

VIII. Authorized Official

Name: MR. ERIC STEVENS
Title or Position: PRESIDENT
Credential:
Phone: 707-456-3010