Basic Information
| Provider Information | |||||||||
| NPI: | 1841331626 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OAK VALLEY HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | OAKDALE COMMUNITY HEALTH CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 S OAK AVE | ||||||||
| Address2: | |||||||||
| City: | OAKDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953613519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2098473011 | ||||||||
| FaxNumber: | 2098487088 | ||||||||
| Practice Location | |||||||||
| Address1: | 1420 W H ST | ||||||||
| Address2: | |||||||||
| City: | OAKDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953613557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2098473011 | ||||||||
| FaxNumber: | 2098484110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 12/18/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CROSKREY | ||||||||
| AuthorizedOfficialFirstName: | ANN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2098484104 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | OAK VALLEY HOSPITAL DISTRICT | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 12/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | 030000069 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | HAP13978F | 05 | CA | MEDICAID | RHM13978F | 05 | CA | MEDICAID | BCP13978F | 05 | CA | MEDICAID |