ADVENTIST HEALTH CLEARLAKE HOSPITAL, INC (NPI# 1093274508) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093274508 |
| Entity Type | Organization |
| Organization Name | ADVENTIST HEALTH CLEARLAKE HOSPITAL, INC |
| Practice Address |
6300 E. Highway 20 Lucerne CA 95458 |
| Mailing Address |
Po Box 6710 Clearlake CA 95422-6710 |
| Practice Telephone | 7072749299 |
| Enumeration Date | 2019-03-14 |
| Last Update Date | 2019-03-14 |
| Authorized Official Name | CARLTON EDWARD JACOBSON (CFO) |
| Authorized Official Telephone | 7079955824 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841626587 | Adventist Health Clearlake Hospital, Inc | General Acute Care Hospital | 9430 Lake St, Lower Lake, CA 95457-8600 | 2013-09-25 |
| 1871063040 | Adventist Health Clearlake Hospital, Inc | Clinic/Center | 801 11th St, Lakeport, CA 95453-4100 | 2018-11-30 |
| 1215383047 | Adventist Health Clearlake Hospital, Inc | Clinic/Center | 900 King St, Arbuckle, CA 95912-0000 | 2016-05-11 |
| 1639151996 | Adventist Health Clearlake Hospital, Inc | Anesthesiology | 15630 18th Avenue, Clearlake, CA 95422-6710 | 2005-11-14 |
| Street Address |
6300 E. HIGHWAY 20 |
| City | LUCERNE |
| State | CA |
| Zip Code | 95458 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619527512 | Shawna Dee Theodorou | Case Manager/Care Coordinator | 6302 Thirteeth Ave, Lucerne, CA 95458 | 2019-09-13 |
| 1750848396 | Catherine Denise Miller | Case Manager/Care Coordinator | 6302 13 Th Ave, Lucerne, CA 95458 | 2019-03-01 |
| 1043774193 | Priest Martinez | Counselor | 6300 E Hwy 20 Unit B, Lucerne, CA 95458 | 2019-01-23 |
| 1700308962 | Joao Adeles Barta | Case Manager/Care Coordinator | 6302 Thirteenth Av., Lucerne, CA 95458 | 2017-07-10 |
| 1154872737 | Deborah Annette Schmidt | Licensed Vocational Nurse | 6302 13th Ave., Lucerne, CA 95458 | 2016-10-19 |
| 1922496199 | Pearlina Drummond | Counselor | 3937 Foothill Drive, Lucerne, CA 95458 | 2014-12-22 |
| 1467881672 | Lucerne Elementary | Local Education Agency (LEA) | 3351 Country Club Drive, Lucerne, CA 95458 | 2013-11-07 |
| 1003245960 | Hilltop Recovery Services | Substance Abuse Rehabilitation Facility | 3937 Foothill Dr, Lucerne, CA 95458 | 2013-11-01 |
| 1053618652 | Chris Partida | Counselor | 6302 13th Ave, Lucerne, CA 95458 | 2011-02-16 |
| 1265747984 | Jamilyn D Trillo | Counselor | 6302 Thirteenth Ave., Lucerne, CA 95458 | 2010-08-18 |
| Find all providers in zip 95458 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376609198 | Lucerne Community Clinic | Clinic/Center | 6300 E. Hwy 20, Lucerne, CA 95458 | 2006-12-28 |
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| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.