1255667234 NPI number — SIERRA STONEGATE

Table of content: (NPI 1255667234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255667234 NPI number — SIERRA STONEGATE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIERRA STONEGATE
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:
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:
1255667234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4140 BUCHANAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIR OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95628-6104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-354-0304
Provider Business Mailing Address Fax Number:
916-941-7498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4140 BUCHANAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIR OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95628-6104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-354-0304
Provider Business Practice Location Address Fax Number:
916-941-7498
Provider Enumeration Date:
10/26/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HILL
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
530-354-0304

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 340099AP , 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: 340099AP . This is a "DRUG AND ALCOHOL PROGRAMS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 340099AP . This is a "RESIDENTIAL CARE FACILITY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 113408 . This is a "AMERICAN ACADEMY OF PAIN MANAGEMENT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com