Healthcare Provider Details

I. General information

NPI: 1245973908
Provider Name (Legal Business Name): SIERRA SAVING GRACE HOMELESS PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 W 20TH ST
MERCED CA
95340-3716
US

IV. Provider business mailing address

PO BOX 1301
MERCED CA
95341-1301
US

V. Phone/Fax

Practice location:
  • Phone: 209-626-5660
  • Fax: 209-626-5465
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN NICOLE BIZZACK
Title or Position: ASSISTANT EXECUTIVE DIRECTOR
Credential:
Phone: 209-626-5660