Provider Demographics
NPI:1073647020
Name:CHW MEDICAL FOUNDATION
Entity Type:Organization
Organization Name:CHW MEDICAL FOUNDATION
Other - Org Name:GERIATRIC NETWORK, A SERVICE OF CHW MEDICAL FOUNDATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HYLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-851-2559
Mailing Address - Street 1:1792 TRIBUTE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4305
Mailing Address - Country:US
Mailing Address - Phone:916-648-2800
Mailing Address - Fax:916-927-7901
Practice Address - Street 1:1792 TRIBUTE RD
Practice Address - Street 2:SUITE 350
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4305
Practice Address - Country:US
Practice Address - Phone:916-648-2800
Practice Address - Fax:916-927-7901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHW MEDICAL FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-14
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8430OtherCOUNTY