Provider Demographics
NPI:1922101377
Name:SIERRA HOPE
Entity Type:Organization
Organization Name:SIERRA HOPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:CADOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-736-6792
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:ANGELS CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95222-0159
Mailing Address - Country:US
Mailing Address - Phone:209-736-6792
Mailing Address - Fax:209-736-6861
Practice Address - Street 1:1168 BOOSTER WAY
Practice Address - Street 2:
Practice Address - City:ANGELS CAMP
Practice Address - State:CA
Practice Address - Zip Code:95222-0159
Practice Address - Country:US
Practice Address - Phone:209-736-6792
Practice Address - Fax:209-736-6861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAYD000460Medicaid