Provider Demographics
NPI:1043353196
Name:VITAS HEALTHCARE CORPORATION CALIFORNIA
Entity Type:Organization
Organization Name:VITAS HEALTHCARE CORPORATION CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEIRDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-350-6925
Mailing Address - Street 1:100 S BISCAYNE BLVD
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2011
Mailing Address - Country:US
Mailing Address - Phone:305-374-4143
Mailing Address - Fax:305-350-6784
Practice Address - Street 1:3700 LAKEVILLE HWY
Practice Address - Street 2:SUITE 205
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-5671
Practice Address - Country:US
Practice Address - Phone:707-787-2200
Practice Address - Fax:707-787-2250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100000781251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01785FMedicaid
CAHPC01785FMedicaid
CA051785Medicare Oscar/Certification