Basic Information
| Provider Information | |||||||||
| NPI: | 1871784587 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SEQUOIA COMMUNITY HEALTH FOUNDATION INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | SEQUOIA COMMUNITY HEALTH CENTERS BULLARD | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1945 N FINE AVE | ||||||||
| Address2: | SUITE 116 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937271528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594575835 | ||||||||
| FaxNumber: | 5594575892 | ||||||||
| Practice Location | |||||||||
| Address1: | 1945 N FINE AVE | ||||||||
| Address2: | SUITE 116 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937271528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594575800 | ||||||||
| FaxNumber: | 5594575892 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2007 | ||||||||
| LastUpdateDate: | 11/20/2007 | ||||||||
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| AuthorizedOfficialLastName: | WAIYAKI | ||||||||
| AuthorizedOfficialFirstName: | SYBILLE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5594575837 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | HAP71144F | 05 | CA | MEDICAID |