Provider Demographics
NPI:1699848713
Name:FREMONT-RIDEOUT MANAGEMENT SERVICES ORGANIZATION, INC.
Entity Type:Organization
Organization Name:FREMONT-RIDEOUT MANAGEMENT SERVICES ORGANIZATION, INC.
Other - Org Name:DBA SIERRA HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-751-7030
Mailing Address - Street 1:939 LIVE OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4002
Mailing Address - Country:US
Mailing Address - Phone:530-751-7030
Mailing Address - Fax:530-751-7044
Practice Address - Street 1:939 LIVE OAK BLVD
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4002
Practice Address - Country:US
Practice Address - Phone:530-751-7030
Practice Address - Fax:530-751-7044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME00507FMedicaid
7012960001Medicare NSC