Provider Demographics
NPI:1285641167
Name:SUTTER COAST HOSPITAL
Entity Type:Organization
Organization Name:SUTTER COAST HOSPITAL
Other - Org Name:SUTTER COAST HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-464-8880
Mailing Address - Street 1:800 E. WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-8359
Mailing Address - Country:US
Mailing Address - Phone:707-464-8511
Mailing Address - Fax:707-464-8886
Practice Address - Street 1:785 E. WASHINGTON BLVD.
Practice Address - Street 2:SUITE 10
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-8343
Practice Address - Country:US
Practice Address - Phone:707-464-8818
Practice Address - Fax:707-464-8848
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUTTER COAST HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-02
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QR1300X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM18519FMedicaid
OR177139Medicaid
HAP18519FOtherHAP
OR177139Medicaid