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General NPI Number Information
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NPI Number | 1255667234
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Entity Type | Organization
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Legal Business Name | SIERRA STONEGATE
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Dates
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Enumeration Date | 10/26/2009
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 4140 BUCHANAN DR
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City | FAIR OAKS
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State | CA
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Zip | 95628-6104
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Country | US
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Telephone | 530-354-0304
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Fax | 916-941-7498
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Provider Business Mailing Address
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Address Line | 4140 BUCHANAN DR
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City | FAIR OAKS
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State | CA
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Zip | 95628-6104
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Country | US
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Telephone | 530-354-0304
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Fax | 916-941-7498
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ANTHONY HILL
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Credential | ADMIN.
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Telephone | 530-354-0304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 340099AP
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License Number State | CA
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