Provider Demographics
NPI:1093884041
Name:MERCY HEALTHCARE SACRAMENTO
Entity Type:Organization
Organization Name:MERCY HEALTHCARE SACRAMENTO
Other - Org Name:MERCY PERINATAL RECOVERY NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOSPITAL PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:UBOLDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-537-5000
Mailing Address - Street 1:650 HOWE AVENUE
Mailing Address - Street 2:SUITE 530
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4682
Mailing Address - Country:US
Mailing Address - Phone:916-614-2240
Mailing Address - Fax:916-564-3160
Practice Address - Street 1:650 HOWE AVENUE
Practice Address - Street 2:SUITE 530
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4682
Practice Address - Country:US
Practice Address - Phone:916-614-2240
Practice Address - Fax:916-564-3160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA343447OtherDRUG MEDICAL PROVIDER NUM