Provider Demographics
NPI:1821396276
Name:SIERRA VISTA CHILD & FAMILY SERVICES
Entity type:Organization
Organization Name:SIERRA VISTA CHILD & FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF QUALITY ASSURANCE
Authorized Official - Prefix:MISS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-523-4610
Mailing Address - Street 1:1600 N CARPENTER RD STE B
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-1185
Mailing Address - Country:US
Mailing Address - Phone:209-523-4573
Mailing Address - Fax:
Practice Address - Street 1:1700 MCHENRY VILLAGE WAY STE 14
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4339
Practice Address - Country:US
Practice Address - Phone:209-312-9580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIERRA VISTA CHILD & FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-09
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA50BTMedicaid