Organization
ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC
Active
Parent organization
ST JOSEPH HEALTH SYSTEM
Other names
St. Joseph Dental, Santa Rosa Memorial Hospital
Organization subpart
Yes
Provider details
NPI number
Legal business name
ST JOSEPH HEALTH SYSTEM
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
751 LOMBARDI CT, SANTA ROSA, CA 95407
(707) 547-2221
(707) 547-2230
Mailing address
PO BOX 31001-3059, PASADENA, CA 91110-3059
(707) 547-2221
(707) 547-2230
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
110000501
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G9048301
MEDI-CAL PROVIDER NUMBER
CA
Enumeration date
02/23/2007
Last updated
05/08/2025
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