=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134798010
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STANDFORD SIERRA YOUTH AND FAMILIES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2021
-----------------------------------------------------
Last Update Date | 06/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8912 VOLUNTEER LN
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95826-3221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-344-0199
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8912 VOLUNTEER LN
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95826-3221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FAMILY SPECIALIST
-----------------------------------------------------
Name | LORENZO WASHINGTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-926-3896
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253J00000X
-----------------------------------------------------
Taxonomy Name | Foster Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------