Provider Demographics
NPI:1063693349
Name:SIERRA JOINT COMMUNITY COLLEGE DISTRICT
Entity type:Organization
Organization Name:SIERRA JOINT COMMUNITY COLLEGE DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR, HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:WENDE
Authorized Official - Middle Name:D
Authorized Official - Last Name:FORTNER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:916-660-7491
Mailing Address - Street 1:250 SIERRA COLLEGE DR
Mailing Address - Street 2:HEALTH CENTER
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5726
Mailing Address - Country:US
Mailing Address - Phone:530-274-5317
Mailing Address - Fax:
Practice Address - Street 1:250 SIERRA COLLEGE DR
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5726
Practice Address - Country:US
Practice Address - Phone:530-274-5317
Practice Address - Fax:530-274-5347
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIERRA JOINT COMMUNITY COLLEGE DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No251300000XAgenciesLocal Education Agency (LEA)