Basic Information
| Provider Information | |||||||||
| NPI: | 1285641167 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SUTTER COAST HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SUTTER COAST HEALTH CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 E. WASHINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | CRESCENT CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955318359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074648511 | ||||||||
| FaxNumber: | 7074648886 | ||||||||
| Practice Location | |||||||||
| Address1: | 785 E. WASHINGTON BLVD. | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | CRESCENT CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955318343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074648818 | ||||||||
| FaxNumber: | 7074648848 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 10/10/2016 | ||||||||
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| AuthorizedOfficialLastName: | HANNA | ||||||||
| AuthorizedOfficialFirstName: | MITCH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7074648880 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SUTTER COAST HOSPITAL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | RHM18519F | 05 | CA | MEDICAID | 177139 | 05 | OR | MEDICAID | HAP18519F | 01 | HAP | OTHER |