Provider Demographics
NPI:1225495633
Name:SIERRA HEALTH CARE MANAGEMENT & SUPPORT SERVICES LLC
Entity Type:Organization
Organization Name:SIERRA HEALTH CARE MANAGEMENT & SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELKANAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUX
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:571-213-4352
Mailing Address - Street 1:3916 12TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2632
Mailing Address - Country:US
Mailing Address - Phone:202-213-7412
Mailing Address - Fax:
Practice Address - Street 1:3916 12TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2632
Practice Address - Country:US
Practice Address - Phone:202-213-7412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC100216000004253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care