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General NPI Number Information
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NPI Number | 1538473061
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Entity Type | Organization
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Legal Business Name | SIERRA LIFENET
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Dates
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Enumeration Date | 07/26/2010
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Last Update Date | 07/26/2010
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Provider Practice Location Address
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Address Line | 101 HOSPITAL RD
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City | SONORA
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State | CA
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Zip | 95370-5227
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Country | US
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Telephone | 209-533-7180
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Fax | 209-533-2885
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Provider Business Mailing Address
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Address Line | 101 HOSPITAL RD
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City | SONORA
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State | CA
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Zip | 95370-5227
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Country | US
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Telephone | 209-533-7180
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Fax | 209-533-2885
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. KATHRYN JOHNSTON
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Credential |
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Telephone | 209-533-7180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 070000520
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License Number State | CA
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