Provider Demographics
NPI:1114392065
Name:HOSPICE OF HUMBOLDT, INC.
Entity Type:Organization
Organization Name:HOSPICE OF HUMBOLDT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:KEATING
Authorized Official - Last Name:VALLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-445-8443
Mailing Address - Street 1:3327 TIMBER FALL CT
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4894
Mailing Address - Country:US
Mailing Address - Phone:707-445-8443
Mailing Address - Fax:707-445-2209
Practice Address - Street 1:3327 TIMBER FALL CT
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4894
Practice Address - Country:US
Practice Address - Phone:707-445-8443
Practice Address - Fax:707-445-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100000737251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01536FMedicaid
051536Medicare PIN