Provider Demographics
NPI:1689869364
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:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:510-450-8521
Mailing Address - Street 1:1900 POWELL ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1811
Mailing Address - Country:US
Mailing Address - Phone:510-450-8500
Mailing Address - Fax:
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:510-450-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA051681Medicare Oscar/Certification