Provider Demographics
NPI:1942430566
Name:CHW MEDICAL FOUNDATION
Entity Type:Organization
Organization Name:CHW MEDICAL FOUNDATION
Other - Org Name:MERCY MEDICAL GROUP, A SERVICE OF CHW MEDICAL FOUNDATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HYLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-851-2559
Mailing Address - Street 1:3000 Q ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-7058
Mailing Address - Country:US
Mailing Address - Phone:916-733-5701
Mailing Address - Fax:916-859-1671
Practice Address - Street 1:4987 GOLDEN FOOTHILL PKWY
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9636
Practice Address - Country:US
Practice Address - Phone:916-933-4222
Practice Address - Fax:916-933-5574
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHW MEDICAL FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-16
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
341996544OtherIRS - SP TIN