Provider Demographics
NPI:1427474394
Name:SYLVAN SURGICAL CENTER, LLC
Entity type:Organization
Organization Name:SYLVAN SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAROSCAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-279-9481
Mailing Address - Street 1:9461 CHARLEVILLE BLVD
Mailing Address - Street 2:SUITE 482
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3017
Mailing Address - Country:US
Mailing Address - Phone:424-279-9481
Mailing Address - Fax:424-279-9482
Practice Address - Street 1:1524 MCHENRY AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4500
Practice Address - Country:US
Practice Address - Phone:209-408-8017
Practice Address - Fax:209-408-8437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical