Provider Demographics
NPI:1962575316
Name:SUTTER HEALTH SACRAMENTO SIERRA REGION
Entity type:Organization
Organization Name:SUTTER HEALTH SACRAMENTO SIERRA REGION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:916-929-0808
Mailing Address - Street 1:855 HOWE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-3912
Mailing Address - Country:US
Mailing Address - Phone:916-929-0808
Mailing Address - Fax:916-649-8657
Practice Address - Street 1:855 HOWE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3912
Practice Address - Country:US
Practice Address - Phone:916-929-0808
Practice Address - Fax:916-649-8657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA030000347261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health