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CAH051309-01 JEROLD PHELPS COMMUNITY HOSPITAL (Active)
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Main Details
Name
JEROLD PHELPS COMMUNITY HOSPITAL
Subdivision Name
SOUTHERN HUMBOLDT COMMUNITY CLINIC
Type
Critical Access Hospital
Rural
No
340B ID
CAH051309-01
Medicare Provider Number
051309
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/14/2017
Participating Start Date
7/1/2017
Participating Approval Date
4/20/2017
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
Southern Humboldt Community Healthcare District
Paul M. Eves, Chief Financial Officer
(707) 923-3921 Ext: 291
Primary Contact
Southern Humboldt Community Healthcare District
Jennifer Lin Gutierrez, Pharmacy Tech
(707) 923-3921 Ext: 270
Addresses
Street Address
509 ELM STREET
GARBERVILLE, CA 95542
Billing Address
SOUTHERN HUMBOLDT COMMUNITY HOSPITAL DISTRICT
733 CEDAR STREET
GARBERVILLE, CA 95542
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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