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General NPI Number Information
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NPI Number | 1710932157
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Entity Type | Organization
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Legal Business Name | ADVENTIST HEALTH MENDOCINO COAST
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 700 RIVER DR
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City | FORT BRAGG
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State | CA
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Zip | 95437-5403
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Country | US
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Telephone | 707-961-4651
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 841941
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City | LOS ANGELES
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State | CA
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Zip | 90084-1941
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JUNICE WILSON
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Credential |
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Telephone | 707-961-4651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 010000146
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License Number State | CA
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