ADVENTIST HEALTH CLEARLAKE HOSPITAL INC. (NPI# 1962492876) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962492876 |
| Entity Type | Organization |
| Organization Name | ADVENTIST HEALTH CLEARLAKE HOSPITAL INC. |
| Other Organization Name | ST. HELENA FAMILY HEALTH CENTER KELSEYVILLE |
| Practice Address |
5290 State St Kelseyville CA 95451-9450 |
| Mailing Address |
Po Box 6710 Clearlake CA 95422-6710 |
| Practice Telephone | 7072798813 |
| Practice Fax Number | 7072792241 |
| Mailing Telephone | 7079946486 |
| Mailing Fax Number | 7079953631 |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2012-04-26 |
| Authorized Official Name | MR. CARLTON JACOBSON (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 7079955820 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
110000174 | CA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | RHM19999G | 05 | |
| CA | BLUE SHIELD | ZZZ49286Z | 01 |
| Other Name | Type Code |
|---|---|
| St. Helena Family Health Center Kelseyville | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972593788 | Adventist Health Clearlake Hospital Inc. | Clinic/Center | 21337 Bush St, Middletown, CA 95461 | 2005-10-24 |
| 1124018031 | Adventist Health Clearlake Hospital Inc. | General Acute Care Hospital | 15630 18th Ave, Clearlake, CA 95422-6710 | 2005-10-24 |
| 1316937121 | Adventist Health Clearlake Hospital Inc. | Clinic/Center | 15230 Lakeshore Drive, Clearlake, CA 95422-6710 | 2005-10-24 |
| 1285054106 | Adventist Health Clearlake Hospital Inc. | Clinic/Center | 155 Solano St, Corning, CA 96021-3511 | 2014-04-17 |
| 1487897047 | Adventist Health Clearlake Hospital Inc. | General Acute Care Hospital | 15630 18th Ave, Clearlake, CA 95422 | 2009-04-13 |
| 1912092792 | Adventist Health Clearlake Hospital Inc. | Clinic/Center | 5125 Skyway, Paradise, CA 95969-5624 | 2006-10-04 |
| Street Address |
5290 STATE ST |
| City | KELSEYVILLE |
| State | CA |
| Zip Code | 95451-9450 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679852958 | Adventist Health California Medical Group, Inc. | Obstetrics & Gynecology | 5290 State St, Kelseyville, CA 95451-9450 | 2011-08-04 |
| 1417093055 | Eunice M Mentges | Registered Nurse | 5290 State St, Kelseyville, CA 95451-9450 | 2007-01-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487705315 | Carol A. Richards Psyd. | Local Education Agency (LEA) | 3970 Main St., Suite 4, Kelseyville, CA 95451 | 2007-01-16 |
| 1316972425 | Paula R Dhanda | Obstetrics & Gynecology | 5685 Main Street, Kelseyville, CA 95451 | 2006-07-11 |
| 1407812019 | Bradley James Smith | Physical Therapist | 5289 State St, Kelseyville, CA 95451 | 2006-04-22 |
| 1851853691 | Pearly Pearly Karunakaran | Dietitian, Registered | 1995 Eastlake Dr, Kelseyville, CA 95451-7012 | 2019-04-02 |
| 1548796055 | Michelle Kay Givens | Physical Therapist | 2718 Greenway Dr, Kelseyville, CA 95451-7028 | 2017-05-03 |
| 1902977044 | Advocates for Independent Living | Intermediate Care Facility, Mentally Retarded | 4795 Gaddy Ln, Kelseyville, CA 95451-7407 | 2006-11-12 |
| 1346246261 | Kelseyville Fire Protection District | Ambulance | 4020 Main St, Kelseyville, CA 95451-7410 | 2005-06-24 |
| 1881616472 | Ruth A Stewart | Pharmacy | 3720 Main St, Kelseyville, CA 95451-7420 | 2006-07-24 |
| 1174740898 | Levi Samuel Palmer | Dentist | 7275 Adobe Creek Dr, Kelseyville, CA 95451-8008 | 2007-04-20 |
| 1790181816 | Erin Bennett | Registered Nurse | 9320 Kelsey Creek Dr, Kelseyville, CA 95451-8031 | 2014-11-17 |
| Find all providers in zip 95451 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821699620 | Reedley Community Hospital | Clinic/Center | 398 S Church Road, Earlimart, CA 93219 | 2020-11-06 |
| 1174130942 | Kaweah Delta Health Care District | Clinic/Center | 1000 N Mooney Blvd, Tulare, CA 93274-2417 | 2020-09-25 |
| 1922614197 | Sierra View Local Health Care District | Clinic/Center | 9520 Road 238, Terra Bella, CA 93270 | 2020-09-22 |
| 1124643598 | Valley Healthcare Centers | Clinic/Center | 369 N Church Rd, Earlimart, CA 93219 | 2020-06-11 |
| 1477177210 | Anand Narayan Md Inc | Clinic/Center | 317 W El Monte Way, Dinuba, CA 93618-1557 | 2020-06-06 |
| 1902435894 | Slt Medical Group Inc | Clinic/Center | 2024 Lake Tahoe Blvd, South Lake Tahoe, CA 96150-6498 | 2020-04-03 |
| 1881232676 | Madera Community Hospital | Clinic/Center | 121 Belmont Ave., Suite 101, Mendota, CA 93640 | 2019-12-12 |
| 1790331817 | Valley Healthcare Centers | Clinic/Center | 252 N Highway 65, Lindsay, CA 93247-2702 | 2019-08-14 |
| 1093274508 | Adventist Health Clearlake Hospital, Inc | Clinic/Center | 6300 E. Highway 20, Lucerne, CA 95458 | 2019-03-14 |
| 1679038434 | Ridgecrest Regional Hospital | Clinic/Center | 105 E Sydnor Ave, Ridgecrest, CA 93555-5546 | 2019-02-06 |
| Find all providers with the same taxonomy | ||||
| City | KELSEYVILLE |
| Zip Code | 95451 |
Please comment or provide details below to improve the information on ADVENTIST HEALTH CLEARLAKE HOSPITAL INC..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.