Provider Demographics
NPI:1083678791
Name:BARTON HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:BARTON HEALTHCARE SYSTEM
Other - Org Name:HOSPICE CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:PURVANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-541-3420
Mailing Address - Street 1:2092 LAKE TAHOE BLVD
Mailing Address - Street 2:STE 500
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6422
Mailing Address - Country:US
Mailing Address - Phone:530-543-5581
Mailing Address - Fax:530-541-2653
Practice Address - Street 1:2092 LAKE TAHOE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-6429
Practice Address - Country:US
Practice Address - Phone:530-543-5581
Practice Address - Fax:530-541-2653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1863HPC13251G00000X
CA100000174251G00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA051711Medicare Oscar/Certification
CA051711Medicare Oscar/Certification