Provider Demographics
NPI:1174526537
Name:SAN DIEGO HOSPICE & PALLIATIVE CARE CORPORATION
Entity type:Organization
Organization Name:SAN DIEGO HOSPICE & PALLIATIVE CARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. FINANCE/CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-688-1600
Mailing Address - Street 1:4311 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1407
Mailing Address - Country:US
Mailing Address - Phone:619-688-1600
Mailing Address - Fax:619-688-0734
Practice Address - Street 1:4311 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1407
Practice Address - Country:US
Practice Address - Phone:619-688-1600
Practice Address - Fax:619-688-0734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000162251E00000X
CA0080000516251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01511FMedicaid
CAZZZ84068ZOtherBLUE SHIELD OF CA
CA051511Medicare ID - Type Unspecified