Provider Demographics
NPI:1669657219
Name:SIERRA JOINT COMMUNITY COLLEGE DISTRICT
Entity Type:Organization
Organization Name:SIERRA JOINT COMMUNITY COLLEGE DISTRICT
Other - Org Name:HEALTH SERVICES - ROCKLIN CAMPUS
Other - Org Type:Other Name
Authorized Official - Title/Position:COORDINATOR, HEALTH SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDE
Authorized Official - Middle Name:D
Authorized Official - Last Name:FORTNER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:916-660-7491
Mailing Address - Street 1:5100 SIERRA COLLEGE BLVD, HEALTH SERVICES
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-3855
Mailing Address - Country:US
Mailing Address - Phone:916-660-7490
Mailing Address - Fax:
Practice Address - Street 1:5100 SIERRA COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-3855
Practice Address - Country:US
Practice Address - Phone:916-660-7490
Practice Address - Fax:916-630-4545
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIERRA JOINT COMMUNITY COLLEGE DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251300000X
CA444305261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No251300000XAgenciesLocal Education Agency (LEA)