Basic Information
| Provider Information | |||||||||
| NPI: | 1588794861 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SIERRA FOREVER FAMILIES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8928 VOLUNTEER LANE #100 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163685114 | ||||||||
| FaxNumber: | 9163685157 | ||||||||
| Practice Location | |||||||||
| Address1: | 345 CROWN POINT CIR STE 300 | ||||||||
| Address2: | |||||||||
| City: | GRASS VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5304780900 | ||||||||
| FaxNumber: | 5304780982 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 05/29/2018 | ||||||||
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| AuthorizedOfficialLastName: | JACOBSEN | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9163685114 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCS 11552 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 251S00000X | 297000560 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.