Provider Demographics
NPI:1609881499
Name:SUTTER COAST HOSPITAL
Entity Type:Organization
Organization Name:SUTTER COAST HOSPITAL
Other - Org Name:SUTTER COAST HOME CARE
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 STE 14&15
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-8343
Practice Address - Country:US
Practice Address - Phone:707-464-8741
Practice Address - Fax:707-464-3742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA010000265251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA07427FMedicaid
CAHHA 07427FMedicaid
CAHHA 07427FMedicaid