1205808375 NPI number — PAJARO VALLEY HEALTH CARE DISTRICT HOSPITAL CORPORATION (PVHCDHC)

Table of content: (NPI 1205808375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205808375 NPI number — PAJARO VALLEY HEALTH CARE DISTRICT HOSPITAL CORPORATION (PVHCDHC)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAJARO VALLEY HEALTH CARE DISTRICT HOSPITAL CORPORATION (PVHCDHC)
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WATSONVILLE COMMUNITY HOSPITAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205808375
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 NIELSON STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATSONVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95076-2468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-763-6040
Provider Business Mailing Address Fax Number:
831-728-4758

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 NIELSON STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATSONVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95076-2468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-763-6040
Provider Business Practice Location Address Fax Number:
831-728-4758
Provider Enumeration Date:
02/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VRANJES
Authorized Official First Name:
MATKO
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
831-763-6040

Provider Taxonomy Codes

  • Taxonomy code: 183500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0580945 . This is a "NABP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: PHB438410 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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