Organization
ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC
Active
Parent organization
ST. JOSEPH HEALTH
Other names
PROVIDENCE FAMILY PRACTICE
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST. JOSEPH HEALTH
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
3302 RENNER DR, FORTUNA, CA 95540
(707) 725-3318
Mailing address
PO BOX 31001-3059, PASADENA, CA 91110-3059
(707) 269-4263
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194189654
—
CA
Enumeration date
04/11/2016
Last updated
05/07/2025
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