Organization
AMERICAN HOSPITAL MANAGEMENT CORPORATION
Active
Other names
MAD RIVER COMMUNITY HOSPITAL
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS ALLEN SHAW (CHIEF EXECUTIVE OFFICER)
(707) 822-7220
Entity
Organization
Contact information
Practice address
3800 JANES RD, ARCATA, CA 95521-4742
(707) 822-3621
(707) 826-8258
Mailing address
PO BOX 1115, ARCATA, CA 95518-1115
(707) 822-3621
(707) 826-8258
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
110000031
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05-0028
BLUE CROSS PROVIDER #
CA
01
—
05U028
MEDICARE SWING BED #
CA
05
—
HSP40028F
—
CA
01
—
HST00028F
MEDI-CAL SWING BED #
CA
05
—
ZZR00028F
—
CA
01
—
ZZZC1209Z
BLUE SHIELD PROVIDER #
CA
Enumeration date
06/30/2006
Last updated
09/20/2019
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