1255401477 NPI number — SUTTER VISITING NURSE ASSOCIATION AND HOSPICE

Table of content: (NPI 1255401477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255401477 NPI number — SUTTER VISITING NURSE ASSOCIATION AND HOSPICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUTTER VISITING NURSE ASSOCIATION AND HOSPICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255401477
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4830 BUSINESS CENTER DR
Provider Second Line Business Mailing Address:
STE 140
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94534-1797
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-771-0328
Provider Business Mailing Address Fax Number:
707-863-9043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1105 ATLANTIC AVE
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
ALAMEDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94501-1184
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-450-8900
Provider Business Practice Location Address Fax Number:
510-652-8278
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCPHERSON
Authorized Official First Name:
MARK
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
707-864-4660

Provider Taxonomy Codes

  • Taxonomy code: 3336C0004X , with the licence number:  LSC 99512 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: PHY 47212 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZZ 098992 . This is a "SUTTER INFUSION PHARMACY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ02700Z . This is a "SUTTER INFUSION PHARMACY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1071252 . This is a "SUTTER INFUSION PHARMACY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: PHA472120 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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