Provider Demographics
NPI:1114190816
Name:AMARA HOSPICE LLC
Entity Type:Organization
Organization Name:AMARA HOSPICE LLC
Other - Org Name:BRIDGE HOSPICE BAY AREA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:MONGONIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-251-4242
Mailing Address - Street 1:3636 NOBEL DR STE 450
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1062
Mailing Address - Country:US
Mailing Address - Phone:858-251-4242
Mailing Address - Fax:
Practice Address - Street 1:46723 FREMONT BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-6539
Practice Address - Country:US
Practice Address - Phone:888-973-1499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001133251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55-1606Medicare PIN