Healthcare Provider Details

I. General information

NPI: 1104059153
Provider Name (Legal Business Name): SUTTER BAY HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 ROWLAND WAY
NOVATO CA
94945-5009
US

IV. Provider business mailing address

PO BOX 742412
LOS ANGELES CA
90074-2412
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-7776
  • Fax: 415-600-7776
Mailing address:
  • Phone: 855-398-1633
  • Fax: 415-600-7776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number110000375
License Number StateCA

VIII. Authorized Official

Name: JOHN B. GATES
Title or Position: CFO
Credential:
Phone: 510-450-7357