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General NPI Number Information
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NPI Number | 1649091679
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Entity Type | Organization
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Legal Business Name | SPROUT ORGANIZATION
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Dates
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Enumeration Date | 10/22/2024
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 101 CREEKSIDE RIDGE CT # 215
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City | ROSEVILLE
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State | CA
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Zip | 95678-3595
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Country | US
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Telephone | 916-826-4665
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Fax | 916-514-5525
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Provider Business Mailing Address
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Address Line | 8815 BELLA TERRA PL
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City | GRANITE BAY
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State | CA
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Zip | 95746-8850
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Country | US
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Telephone | 916-907-2797
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ALINA MUKHOPADHYAY
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Credential |
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Telephone | 916-907-2797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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