Provider Demographics
NPI:1740891084
Name:ROOT CAUSE MEDICAL CLINIC CLW, LLC
Entity type:Organization
Organization Name:ROOT CAUSE MEDICAL CLINIC CLW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF TREATMENT FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPC-A
Authorized Official - Phone:408-733-0400
Mailing Address - Street 1:20398 BLAUER DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-4307
Mailing Address - Country:US
Mailing Address - Phone:408-733-0400
Mailing Address - Fax:408-733-4388
Practice Address - Street 1:1000 S FORT HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3934
Practice Address - Country:US
Practice Address - Phone:727-335-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH NOW MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service