Provider Demographics
NPI:1164527214
Name:HOSPICE OF THE FOOTHILLS
Entity Type:Organization
Organization Name:HOSPICE OF THE FOOTHILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TIPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-274-5157
Mailing Address - Street 1:11270 ROUGH AND READY HWY
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-8530
Mailing Address - Country:US
Mailing Address - Phone:530-272-5739
Mailing Address - Fax:
Practice Address - Street 1:11270 ROUGH AND READY HWY
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-8530
Practice Address - Country:US
Practice Address - Phone:530-272-5739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100000763251G00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA051629001Other051629001
CAHPC01629FMedicaid
CA051629Medicare Oscar/Certification