1972794766 NPI number — SEQUOIA COMMUNITY HEALTH FOUNDATION, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972794766 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:
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:
1972794766
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2007
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
Provider Second Line Business Mailing Address:
SUITE 116
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93727-1528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-457-5835
Provider Business Mailing Address Fax Number:
559-457-5892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6011 N FRESNO STR
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:
08/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WAIYAKI
Authorized Official First Name:
SYBILLE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
559-457-5837

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , 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: BCP71144F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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