Provider Demographics
NPI:1255401477
Name:SUTTER VISITING NURSE ASSOCIATION AND HOSPICE
Entity type:Organization
Organization Name:SUTTER VISITING NURSE ASSOCIATION AND HOSPICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:1105 ATLANTIC AVE
Practice Address - Street 2:STE 102
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-1184
Practice Address - Country:US
Practice Address - Phone:510-450-8900
Practice Address - Fax:510-652-8278
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUTTER VISITING NURSE ASSOICATION AND HOSPICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALSC 995123336C0004X
CAPHY 472123336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ 098992OtherSUTTER INFUSION PHARMACY
CAZZZ02700ZOtherSUTTER INFUSION PHARMACY
CA1071252OtherSUTTER INFUSION PHARMACY
CAPHA472120Medicaid
CA=========OtherSUTTER INFUSION PHARMACY
CA057004Medicare PIN