Healthcare Provider Details

I. General information

NPI: 1780754374
Provider Name (Legal Business Name): UKIAH ADVENTIST HOSPTIAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 S DORA ST SUITE B-1
UKIAH CA
95482-8325
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: JUDSON HOWE
Title or Position: PRESIDENT
Credential:
Phone: 707-456-3010