Basic Information
| Provider Information | |||||||||
| NPI: | 1811611346 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUTTER BAY HOSPITALS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 619092 | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956619092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9162979877 | ||||||||
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| Practice Location | |||||||||
| Address1: | 601 DUBOCE AVE | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941173389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156006000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2022 | ||||||||
| LastUpdateDate: | 09/28/2022 | ||||||||
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| AuthorizedOfficialLastName: | CHENEY | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9166142511 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SUTTER BAY HOSPITALS | ||||||||
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| NPICertificationDate: | 09/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | Y | Hospital Units | Psychiatric Unit |
No ID Information.