Healthcare Provider Details

I. General information

NPI: 1659361392
Provider Name (Legal Business Name): SIERRA NEVADA MEMORIAL-MINERS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 GLASSON WAY
GRASS VALLEY CA
95945-5723
US

IV. Provider business mailing address

3215 PROSPECT PARK DR
RANCHO CORDOVA CA
95670-6017
US

V. Phone/Fax

Practice location:
  • Phone: 530-274-6000
  • Fax: 530-274-6614
Mailing address:
  • Phone: 916-861-1102
  • Fax: 916-861-7707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number230000152
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number230000152
License Number StateCA

VIII. Authorized Official

Name: CAROLYN CANADY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 530-274-6099