Provider Demographics
NPI:1184972713
Name:ST. MARY'S HOSPICE SERVICES, INC.
Entity type:Organization
Organization Name:ST. MARY'S HOSPICE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRBOYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-221-9919
Mailing Address - Street 1:3180 E SHIELDS AVE
Mailing Address - Street 2:SUITE 105A
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-6900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3180 E SHIELDS AVE
Practice Address - Street 2:SUITE 105A
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-6900
Practice Address - Country:US
Practice Address - Phone:559-221-9919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based