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General NPI Number Information
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NPI Number | 1023194222
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Entity Type | Organization
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Legal Business Name | SURPRISE VALLEY HEALTH CARE DISTRICT
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 741 NORTH MAIN ST
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City | CEDARVILLE
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State | CA
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Zip | 96104-0246
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Country | US
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Telephone | 530-279-6111
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Fax | 530-279-2680
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Provider Business Mailing Address
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Address Line | PO BOX 246
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City | CEDARVILLE
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State | CA
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Zip | 96104-0246
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Country | US
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Telephone | 530-279-6111
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Fax | 530-279-2680
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | RICHARD CORNWELL
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Credential |
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Telephone | 530-279-6111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | 230000025
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number | 230000025
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License Number State | CA
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