Organization
SUTTER WEST BAY HOSPITALS
Active
Other names
Sutter Lakeside Community Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN TRENT HUNTER (VP SHARED SERVICES)
(916) 297-8555
Entity
Organization
Contact information
Practice address
750 OLD LUCERNE ROAD, UPPER LAKE, CA 95485-0000
(707) 275-9066
(707) 275-9070
Mailing address
PO BOX 742412, LOS ANGELES, CA 90074-2412
(415) 600-7120
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
110000094
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RKY18547F
—
CA
Enumeration date
09/08/2009
Last updated
01/20/2022
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