Basic Information
| Provider Information | |||||||||
| NPI: | 1891777983 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTRAL VALLEY GENERAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 480 | ||||||||
| Address2: | |||||||||
| City: | HANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932320480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595372106 | ||||||||
| FaxNumber: | 5595857243 | ||||||||
| Practice Location | |||||||||
| Address1: | 1025 N DOUTY ST | ||||||||
| Address2: | |||||||||
| City: | HANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932303722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595874348 | ||||||||
| FaxNumber: | 5595857243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2005 | ||||||||
| LastUpdateDate: | 04/24/2014 | ||||||||
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| AuthorizedOfficialLastName: | LARSEN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO/VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5595370050 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 040000140 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | ZZT30196G | 05 | CA | MEDICAID |