1578540233 NPI number — ST. MARTIN HOSPICE INC

Table of content: (NPI 1578540233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578540233 NPI number — ST. MARTIN HOSPICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. MARTIN HOSPICE 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:
1578540233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1925 W TEMPLE ST
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90026-4972
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-413-4629
Provider Business Mailing Address Fax Number:
213-413-7971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1925 W TEMPLE ST
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90026-4972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-413-4629
Provider Business Practice Location Address Fax Number:
213-413-7971
Provider Enumeration Date:
12/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SORIANO
Authorized Official First Name:
SHIRLEY
Authorized Official Middle Name:
BALDOVINO
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
213-413-4629

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: HCP01754F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com