Provider Demographics
NPI:1730319609
Name:HEALTHY INTERVENTIONS
Entity Type:Organization
Organization Name:HEALTHY INTERVENTIONS
Other - Org Name:SIERRA STONEGATE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:530-354-0304
Mailing Address - Street 1:2634 WATERTREE WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826
Mailing Address - Country:US
Mailing Address - Phone:530-354-0304
Mailing Address - Fax:916-941-7498
Practice Address - Street 1:2634 WATERTREE WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826
Practice Address - Country:US
Practice Address - Phone:530-354-0304
Practice Address - Fax:916-941-7498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-24
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340099AP320800000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA113408OtherAMERICAN ACADEMY OF PAIN MANAGEMENT
CA1447283817OtherMEDICARE NUMBER
CA208103499OtherADMINISTRATOR PSYCHOLOGY
CA340099APOtherSTATE OF CALIFORNIA ALCOHOL AND DRUG TREATMENT