Provider Demographics
NPI:1609202183
Name:SACRAMENTO COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES CHEST CLINIC
Entity Type:Organization
Organization Name:SACRAMENTO COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES CHEST CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHN
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARYL
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:STURDEVANT
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:916-874-9823
Mailing Address - Street 1:7001 EAST PKWY STE 250A
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2501
Mailing Address - Country:US
Mailing Address - Phone:916-876-8852
Mailing Address - Fax:191-639-1076
Practice Address - Street 1:4600 BROADWAY STE 1300
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-1527
Practice Address - Country:US
Practice Address - Phone:916-874-9823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA571220163W00000X, 163WC0400X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty