Provider Demographics
NPI:1649091679
Name:SPROUT ORGANIZATION
Entity type:Organization
Organization Name:SPROUT ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKHOPADHYAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-907-2797
Mailing Address - Street 1:8815 BELLA TERRA PL
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-8850
Mailing Address - Country:US
Mailing Address - Phone:916-907-2797
Mailing Address - Fax:
Practice Address - Street 1:101 CREEKSIDE RIDGE CT # 215
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-3595
Practice Address - Country:US
Practice Address - Phone:916-826-4665
Practice Address - Fax:916-514-5525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251X00000XAgenciesSupports Brokerage