Basic Information
| Provider Information | |||||||||
| NPI: | 1588756530 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SACRAMENTO NATIVE AMERICAN HEALTH CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2020 J ST | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958113120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163410575 | ||||||||
| FaxNumber: | 9163410574 | ||||||||
| Practice Location | |||||||||
| Address1: | 2020 J ST | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958143120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163410575 | ||||||||
| FaxNumber: | 9163410574 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 02/09/2022 | ||||||||
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| AuthorizedOfficialLastName: | GUERRERO | ||||||||
| AuthorizedOfficialFirstName: | BRITTA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9163410576 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 02/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Case Manager/Care Coordinator | 261QF0400X | 030000183 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | FHC11575H | 05 | CA | MEDICAID |