Basic Information
| Provider Information | |||||||||
| NPI: | 1427322262 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SIERRA FOREVER FAMILIES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 275 NEVADA ST | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956034617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308879982 | ||||||||
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| Practice Location | |||||||||
| Address1: | 275 NEVADA ST | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308879982 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2012 | ||||||||
| LastUpdateDate: | 05/29/2018 | ||||||||
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| AuthorizedOfficialLastName: | JACOBSEN | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9163685114 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 317004049 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.