Healthcare Provider Details

I. General information

NPI: 1629432968
Provider Name (Legal Business Name): UKIAH ADVENTIST HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MARCELA DR STE B
WILLITS CA
95490-5769
US

IV. Provider business mailing address

1 MARCELA DR
WILLITS CA
95490-5769
US

V. Phone/Fax

Practice location:
  • Phone: 707-456-3005
  • Fax:
Mailing address:
  • Phone: 707-459-6801
  • Fax: 707-459-9486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateCA

VIII. Authorized Official

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