Healthcare Provider Details

I. General information

NPI: 1770653362
Provider Name (Legal Business Name): UKIAH ADVENTIST HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 N STATE ST
UKIAH CA
95482-3414
US

IV. Provider business mailing address

PO BOX 888867
LOS ANGELES CA
90088-8867
US

V. Phone/Fax

Practice location:
  • Phone: 707-463-8000
  • Fax: 707-462-1111
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number110000095
License Number StateCA

VIII. Authorized Official

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