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DSH050057J KAWEAH DELTA HEALTH CARE DISTRICT (Terminated)
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Main Details
Name
KAWEAH DELTA HEALTH CARE DISTRICT
Subdivision Name
KAWEAH DELTA MENTAL HEALTH HOSPITAL
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050057J
Medicare Provider Number
050057
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/11/2008
Participating Start Date
4/1/2006
Participating Approval Date
4/11/2008
Last Recertification Date
8/12/2015
Termination Date
Termination Reason
7/1/2016
Site closure
Contacts
Authorizing Official
Kaweah Delta Health Care District
GARY K. HERBST, Chief Executive Officer
(559) 624-2330
Primary Contact
Coby La Blue, DIRECTOR OF FINANCIAL AND LOGISTICAL PLANNING
(559) 624-2356
Addresses
Street Address
1100 S AKERS
VISALIA, CA 93277
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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