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General NPI Number Information
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NPI Number | 1043292303
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Entity Type | Organization
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Legal Business Name | ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC
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Dates
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Enumeration Date | 11/14/2005
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 3300 RENNER DR
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City | FORTUNA
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State | CA
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Zip | 95540
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Country | US
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Telephone | 707-725-3361
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Fax | 707-725-7212
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Provider Business Mailing Address
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Address Line | PO BOX 31001-3059
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City | PASADENA
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State | CA
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Zip | 91110-3059
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Country | US
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Telephone | 707-725-3361
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Fax | 707-725-7212
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Authorized Official
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Title or Position | ASSISTANT SECRETARY OF ENROLLMENTS
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Name | DONALD WAYNE ANDERSON JR.
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Credential |
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Telephone | 425-358-9786
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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 | 110000173
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License Number State | CA
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