Organization
ADVENTIST HEALTH CLEARLAKE HOSPITAL INC.
Active
Other names
Adventist Health Clear Lake
Organization subpart
No
Provider details
NPI number
Authorized official
PARKER J PRIDGEN (PRESIDENT)
(707) 467-5200
Entity
Organization
Contact information
Practice address
5290 STATE ST, KELSEYVILLE, CA 95451-9450
(707) 279-8813
(707) 279-2241
Mailing address
PO BOX 888837, LOS ANGELES, CA 90088-8837
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
110000174
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RHM19999G
—
CA
01
—
ZZZ49286Z
BLUE SHIELD
CA
Enumeration date
10/24/2005
Last updated
09/15/2025
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