1386636397 NPI number — HOSPICE OF THE VALLEY

Table of content: (NPI 1386636397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386636397 NPI number — HOSPICE OF THE VALLEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPICE OF THE VALLEY
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:
1386636397
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4850 UNION AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95124-5156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-559-5600
Provider Business Mailing Address Fax Number:
408-559-5320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4850 UNION AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95124-5156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-559-5600
Provider Business Practice Location Address Fax Number:
408-559-3520
Provider Enumeration Date:
08/16/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ADELUS
Authorized Official First Name:
SALLY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
408-559-5600

Provider Taxonomy Codes

  • Taxonomy code: 163WH1000X , with the licence number:  070000396 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X , with the licence number: 070000396 , 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)

  • Identifier: HPC01507F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1386636397 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".