Provider Demographics
NPI:1619384468
Name:SIERRA COUNTY VICTIM ASSISTANCE
Entity type:Organization
Organization Name:SIERRA COUNTY VICTIM ASSISTANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/ADVOCATE
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-740-0190
Mailing Address - Street 1:PO BOX 3343
Mailing Address - Street 2:
Mailing Address - City:TRUTH OR CONSEQUENCES
Mailing Address - State:NM
Mailing Address - Zip Code:87901-7343
Mailing Address - Country:US
Mailing Address - Phone:575-297-4044
Mailing Address - Fax:
Practice Address - Street 1:1301 N PERSHING ST
Practice Address - Street 2:
Practice Address - City:TRUTH OR CONSEQUENCES
Practice Address - State:NM
Practice Address - Zip Code:87901-1772
Practice Address - Country:US
Practice Address - Phone:575-297-4044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health