Provider Demographics
NPI:1437250537
Name:SACRAMENTO HEARING SERVICES CENTER, INC.
Entity Type:Organization
Organization Name:SACRAMENTO HEARING SERVICES CENTER, INC.
Other - Org Name:AGENCY FOR HEARING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-732-9040
Mailing Address - Street 1:1800 28TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-7310
Mailing Address - Country:US
Mailing Address - Phone:916-732-9040
Mailing Address - Fax:916-454-4559
Practice Address - Street 1:1800 28TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7310
Practice Address - Country:US
Practice Address - Phone:916-732-9040
Practice Address - Fax:916-454-4559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGAU000730OtherMEDICAL
CAZZZ21550ZMedicare ID - Type Unspecified