Healthcare Provider Details

I. General information

NPI: 1407898265
Provider Name (Legal Business Name): SUTTER CENTRAL VALLEY HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 COFFEE ROAD STE. 110
MODESTO CA
95355-2803
US

IV. Provider business mailing address

PO BOX 740152
LOS ANGELES CA
90074-0152
US

V. Phone/Fax

Practice location:
  • Phone: 209-569-7642
  • Fax:
Mailing address:
  • Phone: 855-398-1633
  • Fax: 209-569-7362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License NumberHSP37596
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberHSP37596
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberHSP37596
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberHSP37596
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number030000061
License Number StateCA

VIII. Authorized Official

Name: MR. BRIAN TRENT HUNTER
Title or Position: VP SHARED SERVICES
Credential:
Phone: 916-297-8555