Provider Demographics
NPI:1255667234
Name:SIERRA STONEGATE
Entity Type:Organization
Organization Name:SIERRA STONEGATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:ADMIN
Authorized Official - Phone:530-354-0304
Mailing Address - Street 1:4140 BUCHANAN DR
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-6104
Mailing Address - Country:US
Mailing Address - Phone:530-354-0304
Mailing Address - Fax:916-941-7498
Practice Address - Street 1:4140 BUCHANAN DR
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-6104
Practice Address - Country:US
Practice Address - Phone:530-354-0304
Practice Address - Fax:916-941-7498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320800000X
CA340099AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA340099APOtherDRUG AND ALCOHOL PROGRAMS
CA340099APOtherRESIDENTIAL CARE FACILITY
CA113408OtherAMERICAN ACADEMY OF PAIN MANAGEMENT