MEDICARE: SUTTER HEALTH SACRAMENTO SIERRA REGION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center	030000347	CA

General Provider Information

NPI Number	:	1962575316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUTTER HEALTH SACRAMENTO SIERRA REGION

Provider Business Mailing Address
First Line	:	855 HOWE AVE
Second Line	:	SUITE 1
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-3912
Country	:	US
Telephone Number	:	916-929-0808
Fax Number	:	916-649-8657

Provider Business Practice Location Address
First Line	:	855 HOWE AVE
Second Line	:	SUITE 1
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-3912
Country	:	US
Telephone Number	:	916-929-0808
Fax Number	:	916-649-8657

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. MICHAEL JAMES ROGERS
Credential	:	LCSW
Telephone Number	:	916-929-0808

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	01/07/2022

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