1255668547 NPI number — 5 STAR HOSPICE CARE, INC.

Table of content: (NPI 1255668547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255668547 NPI number — 5 STAR HOSPICE CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
5 STAR HOSPICE CARE, 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:
6
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:
1255668547
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13375 UNIVERSITY AVENUE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
CLIVE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50325-8260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-221-9155
Provider Business Mailing Address Fax Number:
515-221-9157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
675 S. ARROYO PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91105-3264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-229-9855
Provider Business Practice Location Address Fax Number:
626-229-9856
Provider Enumeration Date:
11/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HOGAN
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
515-221-9155

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  550001417 , 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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