1891811907 NPI number — HAZEL HAWKINS MEMORIAL HOSPITAL

Table of content: (NPI 1891811907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891811907 NPI number — HAZEL HAWKINS MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAZEL HAWKINS MEMORIAL HOSPITAL
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:
1891811907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
911 SUNSET DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLISTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95023-5602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-637-5711
Provider Business Mailing Address Fax Number:
831-637-3126

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 THE ALAMEDA
Provider Second Line Business Practice Location Address:
SUITE B3
Provider Business Practice Location Address City Name:
SAN JUAN BAUTISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95045-9746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-623-4615
Provider Business Practice Location Address Fax Number:
831-623-4689
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CASILLAS
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
831-636-2604

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  070000004 , 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: RHM08590F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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