Provider Demographics
NPI:1821171877
Name:SUTTER VISITING NURSE ASSOCIATION AND HOSPICE
Entity Type:Organization
Organization Name:SUTTER VISITING NURSE ASSOCIATION AND HOSPICE
Other - Org Name:SUTTER INFUSION & PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-864-4660
Mailing Address - Street 1:4830 BUSINESS CENTER DR
Mailing Address - Street 2:STE 140
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1797
Mailing Address - Country:US
Mailing Address - Phone:855-771-0328
Mailing Address - Fax:707-863-9043
Practice Address - Street 1:8318 FERGUSON AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-0902
Practice Address - Country:US
Practice Address - Phone:916-379-3200
Practice Address - Fax:866-932-7052
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUTTER VISITING NURSE ASSOCIATION AND HOSPICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-23
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA450663336H0001X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA450660Medicaid
CAZZZ02700ZOtherSUTTER INFUSION PHARMACY
CA1071252OtherSUTTER INFUSION PHARMACY
CAZZZ 098992OtherSUTTER INFUSION PHARMACY
CAPHA450660Medicaid
CAPHA450660Medicaid