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General NPI Number Information
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NPI Number | 1003819376
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Entity Type | Organization
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Legal Business Name | SOUTHERN HUMBOLDT COMMUNITY HEALTHCARE DISTRICT
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 07/01/2021
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Provider Practice Location Address
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Address Line | 733 CEDAR ST
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City | GARBERVILLE
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State | CA
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Zip | 95542-3201
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Country | US
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Telephone | 707-923-3921
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Fax | 707-923-1456
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Provider Business Mailing Address
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Address Line | 733 CEDAR ST
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City | GARBERVILLE
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State | CA
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Zip | 95542-3201
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Country | US
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Telephone | 707-923-3921
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Fax | 707-923-1456
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Authorized Official
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Title or Position | MED STAFF COORDINATOR
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Name | SUSAN LEE GARDNER
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Credential |
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Telephone | 707-923-3921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 110000052
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License Number State | CA
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