Basic Information
| Provider Information | |||||||||
| NPI: | 1144343609 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SIERRA CHILD AND FAMILY SERVICES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SIERRA CHILD AND FAMILY SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1987 | ||||||||
| Address2: | |||||||||
| City: | DIAMOND SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956191987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306263105 | ||||||||
| FaxNumber: | 5306421233 | ||||||||
| Practice Location | |||||||||
| Address1: | 4250 FOWLER LN. SUITE 204 | ||||||||
| Address2: | |||||||||
| City: | DIAMOND SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306263105 | ||||||||
| FaxNumber: | 5306421233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2007 | ||||||||
| LastUpdateDate: | 01/05/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HARWELL | ||||||||
| AuthorizedOfficialFirstName: | BARRY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5306262589 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.