Provider Demographics
NPI:1457367062
Name:SUTTER COAST HOSPITAL
Entity Type:Organization
Organization Name:SUTTER COAST HOSPITAL
Other - Org Name:SUTTER COAST HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO AND VP OF FINANCE SH VALLEY ARE
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-887-7050
Mailing Address - Street 1:800 E WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-8359
Mailing Address - Country:US
Mailing Address - Phone:707-464-8511
Mailing Address - Fax:707-464-8939
Practice Address - Street 1:800 E WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-8359
Practice Address - Country:US
Practice Address - Phone:707-464-8511
Practice Address - Fax:707-464-8939
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUTTER COAST HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-01
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHSP00417G273Y00000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP40417GMedicaid
OR177139Medicaid
CAZZZC0802ZOtherBLUE SHIELD
CAHSP40417GMedicaid
OR177139Medicaid
OR177139Medicaid
CAZZZ11790ZMedicare PIN