| Organization Name: | ADVENTIST HEALTH CLEARLAKE HOSPITAL INC. |
| NPI Number: | 1962492876 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CARLTON JACOBSON (CHIEF FINANCIAL OFFICER) |
| Mailing Address: | 5290 State St Kelseyville |
| State: | CA US |
| Postal Code: | 954519450 |
| Phone Number: | 7072798813 |
| Fax Number: | 7072792241 |
| NPI Enumeration Date: | 10/24/2005 |
| NPI Last Update Date: | 04/26/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | 110000174 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |