1003068172 NPI number — ABRIDGE HOSPICE AND PALLIATIVE CARE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003068172 NPI number — ABRIDGE HOSPICE AND PALLIATIVE CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABRIDGE HOSPICE AND PALLIATIVE CARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003068172
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
973 VALE TERRACE DR
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92084-5251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-643-0400
Provider Business Mailing Address Fax Number:
760-643-0402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
973 VALE TERRACE DR
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92084-5251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-643-0400
Provider Business Practice Location Address Fax Number:
760-643-0402
Provider Enumeration Date:
10/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
KELTON
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/ADM
Authorized Official Telephone Number:
760-643-0400

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  550000796 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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