Provider Demographics
NPI:1972876506
Name:SUTTER VISITING NURSE ASSOCIATION AND HOSPICE
Entity type:Organization
Organization Name:SUTTER VISITING NURSE ASSOCIATION AND HOSPICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-864-4660
Mailing Address - Street 1:4830 BUSINESS CENTER DR
Mailing Address - Street 2:STE 140
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1797
Mailing Address - Country:US
Mailing Address - Phone:855-771-0328
Mailing Address - Fax:707-863-9043
Practice Address - Street 1:1316 CELESTE DR STE 140
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2437
Practice Address - Country:US
Practice Address - Phone:209-571-1055
Practice Address - Fax:209-342-4039
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUTTER VISITING NURSE ASSOCIATION AN HOSPICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-13
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA057695Medicare Oscar/Certification