Organization
SOUTHERN HUMBOLDT COMMUNITY HEALTHCARE DISTRICT
Active
Other names
Southern Humboldt Community Hospital District, Jerold Phelps Community Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN LEE GARDNER (MED STAFF COORDINATOR)
(707) 923-3921
Entity
Organization
Contact information
Practice address
733 CEDAR ST, GARBERVILLE, CA 95542-3201
(707) 923-3921
(707) 923-1456
Mailing address
733 CEDAR ST, GARBERVILLE, CA 95542-3201
(707) 923-3921
(707) 923-1456
Taxonomy
Speciality
Code
Description
License number
State
282NC0060X
Critical Access Hospital
Primary
110000052
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050482
BLUE CROSS INPATIENT & OUTPATIENT
CA
01
—
174988
ARIZONA MEDICAID
AZ
01
—
272260
OREGON MEDICAID
OR
01
—
3003993
WASHINGTON MEDICAID
WA
01
—
HSP30482G
MEDI-CAL INPATIENT
CA
01
—
HSP40482G
MEDI-CAL OUTPATIENT
CA
01
—
ZZZJ1202Z
BLUE SHIELD
CA
Enumeration date
05/31/2005
Last updated
07/01/2021
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