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General NPI Number Information
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NPI Number | 1962492876
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Entity Type | Organization
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Legal Business Name | ADVENTIST HEALTH CLEARLAKE HOSPITAL INC.
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 5290 STATE ST
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City | KELSEYVILLE
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State | CA
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Zip | 95451-9450
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Country | US
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Telephone | 707-279-8813
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Fax | 707-279-2241
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Provider Business Mailing Address
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Address Line | PO BOX 888837
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City | LOS ANGELES
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State | CA
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Zip | 90088-8837
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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 | PRESIDENT
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Name | PARKER J PRIDGEN
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Credential |
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Telephone | 707-467-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 110000174
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License Number State | CA
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