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Organization

ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC

Active
Parent organization
ST JOSEPH HEALTH SYSTEM
Other names
St. Joseph Mobile Health Clinic, Santa Rosa Memorial Hospital
Organization subpart
Yes

Provider details

NPI number
Legal business name
ST JOSEPH HEALTH SYSTEM
Authorized official
DONALD WAYNE ANDERSON JR. (DIRECTOR-REIMBURSEMENT ADMINISTRATI)
(425) 525-5392
Entity
Organization

Contact information

Practice address
1450 MEDICAL CENTER DRIVE, SUITE 3, ROHNERT PARK, CA 94928
(707) 547-4652
Mailing address
1450 MEDICAL CENTER DRIVE, SUITE 3, ROHNERT PARK, CA 94928-2933
(707) 547-4652

Taxonomy

Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
140000648
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
050174
MEDICARE PROVIDER NUMBER
CA
01
110000497
LICENSE
CA
05
CMM70966F
CA
Enumeration date
02/27/2007
Last updated
08/15/2018
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