Provider Demographics
NPI:1780818898
Name:SUTTER MEDICAL FOUNDATION
Entity Type:Organization
Organization Name:SUTTER MEDICAL FOUNDATION
Other - Org Name:SUTTER NORTH HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KREVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-286-6732
Mailing Address - Street 1:PO BOX 619044
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-9044
Mailing Address - Country:US
Mailing Address - Phone:916-797-7805
Mailing Address - Fax:
Practice Address - Street 1:400 PLUMAS BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-5081
Practice Address - Country:US
Practice Address - Phone:530-749-3450
Practice Address - Fax:530-749-3486
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUTTER MEDICAL FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-05
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000278251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01751FMedicaid
CAHPC01751FMedicaid