Provider Demographics
NPI:1124205067
Name:KELLI A. FOX
Entity Type:Organization
Organization Name:KELLI A. FOX
Other - Org Name:GOLDEN STATE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-451-9020
Mailing Address - Street 1:1230 W BALBOA BLVD
Mailing Address - Street 2:#E
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92661-1061
Mailing Address - Country:US
Mailing Address - Phone:801-451-9020
Mailing Address - Fax:866-299-5156
Practice Address - Street 1:1230 W BALBOA BLVD
Practice Address - Street 2:#E
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92661-1061
Practice Address - Country:US
Practice Address - Phone:801-451-9020
Practice Address - Fax:866-299-5156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based