1396754115 NPI number — MISSION HOSPICE & HOME CARE, INC.

Table of content: (NPI 1396754115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396754115 NPI number — MISSION HOSPICE & HOME CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISSION HOSPICE & HOME 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:
1396754115
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
66 BOVET RD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN MATEO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94402-3126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-554-1000
Provider Business Mailing Address Fax Number:
650-554-1018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
66 BOVET ROAD SUITE 100
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
SAN MATEO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94402-3126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-554-1000
Provider Business Practice Location Address Fax Number:
650-554-1018
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
IGNACIO
Authorized Official First Name:
ALEX
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF ADMINISTRATIVE OFFICER
Authorized Official Telephone Number:
650-554-1000

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  0700584 , 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: 0700000584 , 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: CA502834 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051665 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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