1629118898 NPI number — HOSPICE OF ST. MARY INC.

Table of content: (NPI 1629118898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629118898 NPI number — HOSPICE OF ST. MARY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPICE OF ST. MARY INC.
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:
1629118898
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1985 YOSEMITE AVE
Provider Second Line Business Mailing Address:
STE 240
Provider Business Mailing Address City Name:
SIMI VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93063-5234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-306-0440
Provider Business Mailing Address Fax Number:
805-306-0880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1985 YOSEMITE AVE
Provider Second Line Business Practice Location Address:
STE 240
Provider Business Practice Location Address City Name:
SIMI VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93063-5234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-389-2130
Provider Business Practice Location Address Fax Number:
805-306-0880
Provider Enumeration Date:
02/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ZILFINYAN
Authorized Official First Name:
NUNE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
805-306-0440

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  550000056 , 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)