Provider Demographics
NPI:1598791733
Name:SUTTER VISITING NURSE ASSOCIATION AND HOSPICE
Entity Type:Organization
Organization Name:SUTTER VISITING NURSE ASSOCIATION AND HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-614-1411
Mailing Address - Street 1:4600 S TRACY BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-8105
Mailing Address - Country:US
Mailing Address - Phone:209-830-5310
Mailing Address - Fax:209-832-2195
Practice Address - Street 1:4600 S TRACY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-8105
Practice Address - Country:US
Practice Address - Phone:209-830-5310
Practice Address - Fax:209-832-2195
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUTTER VISITING NURSE ASSOCIATION AND HOSPICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-22
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-7723Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER