NPIMap

Organization Active NPI

Adventist Health Mendocino Coast

  • Home Health Agency
  • Fort Bragg, CA
National Provider Identifier
1710932157
Registry record updated Sep 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
010000146 Issued in CA
Legal business name
ADVENTIST HEALTH MENDOCINO COAST
Practice address
700 River Dr
Fort Bragg, CA 95437-5403
Phone
(707) 961-4651
NPI assigned
May 24, 2006
Last updated
Sep 18, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Junice Wilson
Title
Director
Phone
(707) 961-4651

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 010000146 CA Primary

Addresses

Primary practice location

700 River Dr
Fort Bragg, CA 95437-5403

Mailing address

PO Box 841941
Los Angeles, CA 90084-1941

Other identifiers 1

IdentifierTypeStateIssuer
HHA07746FMedicaidCA

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark LLC / Office Ally

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201012002025 CA Part A Provider - Home Health Agency 3678990769 Practice locations: Fort Bragg, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710932157. Details of each certification follow.

Home health agency certification: CCN 057746

Legal name
ADVENTIST HEALTH MENDOCINO COAST
Doing business as
ADVENTIST HEALTH HOME CARE SERVICES
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jul 2, 1986
Last certification
Feb 15, 2018
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
Mar 17, 2020 in CA
Enrollment address
700 River Dr
Fort Bragg, CA 95437-5403

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Adventist Health Home Care ServicesCCN 057746 · All quality measures
Overall star rating
3 of 5
Ownership
Non-Profit
Certified
Jul 2, 1986
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Adventist Health Mendocino Coast2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kerry L Heinrich Individual Corporate OfficerChair Jan 24, 2022
Meredith S Jobe Individual Corporate OfficerSecretary Mar 18, 2020
Eric a Stevens Individual Corporate OfficerVice Chair Jul 8, 2024
Richard K Reiner Individual Corporate DirectorBoard Member Mar 18, 2020
Richard R Riter Individual Corporate OfficerTreasurer Jun 26, 2025
Stone Point Health Organization, Roseville, CA Non-profit Operational/Managerial Control Jun 1, 2020 100%
Parker J Pridgen Individual Corporate OfficerPresident Aug 15, 2025
W-2 Managing EmployeeAd; Aug 15, 2025
Larry L Innocent Individual Corporate DirectorBoard Member Mar 18, 2020
Stephanie L Shettlesworth Individual W-2 Managing EmployeeAd; Oct 9, 2025
Operational/Managerial ControlAdministrator Oct 9, 2025

Facilities with the same owner 9

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Change-of-ownership history 2

DateEventCounterparty
Jul 1, 2020 Change of OwnershipThis provider was the buyer Mendocino Coast Home HealthCCN 057746, CA, NPI 1710932157
Jul 1, 2020 Change of OwnershipThis provider was the seller Adventist Health Home Care ServicesCCN 057746, CA, NPI 1710932157

Practitioners & affiliated clinicians

Affiliated clinicians 10

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758153600000",
    "number": "1710932157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 841941",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900841941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 RIVER DR",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954375403",
            "telephone_number": "707-961-4651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVENTIST HEALTH MENDOCINO COAST",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2025-09-18",
        "certification_date": "2025-09-18",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "JUNICE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "707-961-4651"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": "010000146",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HHA07746F",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "700 River Dr",
            "city": "Fort Bragg",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954375403",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Bragg, CA

Sources for this page

Verify at the official NPI Registry.