1871651703 NPI number — SEQUOIA COMMUNITY HEALTH FOUNDATION, INC

Table of content: (NPI 1871651703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871651703 NPI number — SEQUOIA COMMUNITY HEALTH FOUNDATION, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEQUOIA COMMUNITY HEALTH FOUNDATION, INC
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:
SEQUOIA COMMUNITY HEALTH CENTERS
Provider Other Organization Name Type Code:
3
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:
1871651703
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1945 N. FINE AVE, SUITE #116
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-457-5236
Provider Business Mailing Address Fax Number:
559-457-5891

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6011 N FRESNO ST
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93710-5274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-457-6800
Provider Business Practice Location Address Fax Number:
559-457-6890
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WAIYAKI
Authorized Official First Name:
SYBILLE
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCE DIRECTOR
Authorized Official Telephone Number:
559-457-5237

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  550000220 , 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: FHC71144F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ05847Z . This is a "MEDICARE PART B/NHIC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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