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ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC
NPI 1194189654
Clinic/Center - Rural Health in Fortuna, CA

Active since April 11, 2016
3302 RENNER DR, FORTUNA, CA 95540(707) 725-3318 Get Directions Write a Review

NPPES record last updated: May 7, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 7, 2025, Jul 14, 2021, Aug 9, 2018 (3 updates tracked since 2018).

About St. Joseph Health Northern California, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC (NPI 1194189654), doing business as Providence Family Practice, is a healthcare organization registered as a rural health in Fortuna, California and active in the NPI registry since April 2016. The organization lists Donald Wayne Anderson, Assistant Secretary Of Enrollments, as its authorized official.

NPPES Registry Identity

NPI1194189654
Entity TypeOrganization
Primary Taxonomy261QR1300X
Legal Business NameST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC
Location Address3302 RENNER DRFortuna, CA 95540
Mailing AddressPo Box 31001-3059Pasadena, CA 91110-3059 · (707) 269-4263
Phone(707) 725-3318
Organization SubpartYesParent: St. Joseph Health
Authorized OfficialDonald Wayne AndersonAssistant Secretary Of Enrollments · (425) 358-9786
Enumeration DateApril 11, 2016
Last NPPES UpdateMay 7, 20253 updates tracked since enumeration
NPPES CertifiedMay 7, 2025
✔ NPI 1194189654 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Rural HealthAmbulatory Health Care Facilities
Taxonomy Code261QR1300X
3302 RENNER DR, Fortuna, CA 95540
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Other Names 1

Doing Business AsProvidence Family Practice

Other Identifiers 1

Medicaid1194189654CA

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AMBER FORD
Nurse Practitioner (Family)
3302 RENNER DR
FORTUNA, CA 95540
Humboldt County (707) 725-3318
JOHNNY KEITH COLEMAN P.A.-C.
Nurse Practitioner (Primary Care)
3302 RENNER DR
FORTUNA, CA 95540
Humboldt County (707) 725-3318
DANIEL ALAN HEYN MD
Family Medicine
3302 RENNER DR
FORTUNA, CA 95540
Humboldt County (707) 725-3318
PHILIP L OLKIN M.D.
Family Medicine
3302 RENNER DR
FORTUNA, CA 95540
Humboldt County (707) 725-3318
PHILIP L. OLKIN, M.D. AND C. RAY JONES, M.D.
Family Medicine
3302 RENNER DR
FORTUNA, CA 95540
Humboldt County (707) 725-3318
ANDREW ALLEN BILLINGS FNP
Nurse Practitioner (Primary Care)
3302 RENNER DR
FORTUNA, CA 95540
Humboldt County (707) 725-3318

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is St. Joseph Health Northern California, LLC's NPI number?

The NPI number for St. Joseph Health Northern California, LLC is 1194189654. It was assigned to this organization in the NPPES registry on April 11, 2016. The provider is doing business as Providence Family Practice.

Where is St. Joseph Health Northern California, LLC located?

St. Joseph Health Northern California, LLC is located at 3302 Renner Dr, Fortuna, CA 95540. The listed phone number is (707) 725-3318.

What is St. Joseph Health Northern California, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.

When was this NPI record last updated?

The NPPES record for St. Joseph Health Northern California, LLC was last updated on May 7, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.