Healthcare Provider Details

I. General information

NPI: 1639487366
Provider Name (Legal Business Name): SUTTON FOUNDATION INC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 RED ROCK
IRVINE CA
92604-3061
US

IV. Provider business mailing address

1733 S DOUGLASS RD UNIT-K
ANAHEIM CA
92806-6034
US

V. Phone/Fax

Practice location:
  • Phone: 714-978-0365
  • Fax: 714-978-0381
Mailing address:
  • Phone: 714-978-0365
  • Fax: 714-978-0381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. DORTHA SEAY
Title or Position: PRESIDENT
Credential:
Phone: 714-978-0365