Provider Demographics
NPI:1760432447
Name:SUTTER HEALTH SACRAMENTO SIERRA REGION
Entity Type:Organization
Organization Name:SUTTER HEALTH SACRAMENTO SIERRA REGION
Other - Org Name:SUTTER OAKS MIDTOWN (SOMT)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CBO DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ACKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-978-8701
Mailing Address - Street 1:PO BOX 160100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-0100
Mailing Address - Country:US
Mailing Address - Phone:800-353-3369
Mailing Address - Fax:
Practice Address - Street 1:2600 L ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5612
Practice Address - Country:US
Practice Address - Phone:800-353-3369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUTTER HEALTH SACRAMENTO SIERRA REGION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-11
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA030000102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05493HMedicaid
CAZZR05493HMedicaid