Provider Demographics
NPI:1750305371
Name:AMERICAN HOSPITAL MANAGEMENT CORPORATION
Entity type:Organization
Organization Name:AMERICAN HOSPITAL MANAGEMENT CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-822-7220
Mailing Address - Street 1:PO BOX 1115
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95518-1115
Mailing Address - Country:US
Mailing Address - Phone:707-826-8420
Mailing Address - Fax:707-826-8428
Practice Address - Street 1:4605 VALLEY WEST BLVD
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4635
Practice Address - Country:US
Practice Address - Phone:707-826-8420
Practice Address - Fax:707-826-8428
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN HOSPITAL MANAGEMENT CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-27
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA010000166251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA70137FMedicaid
CA057524OtherBLUE CROSS OF CALIFORNIA
CAZZZ97638ZOtherBLUE SHIELD OF CALIFORNIA
CA057524Medicare ID - Type Unspecified