Provider Demographics
NPI:1174590574
Name:HOSPICE BY THE SEA, LTD
Entity type:Organization
Organization Name:HOSPICE BY THE SEA, LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CHPS, DPCS
Authorized Official - Phone:858-794-0195
Mailing Address - Street 1:312 S. CEDROS AVENUE
Mailing Address - Street 2:STE 250
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1988
Mailing Address - Country:US
Mailing Address - Phone:858-794-0195
Mailing Address - Fax:858-794-0147
Practice Address - Street 1:312 S. CEDROS AVENUE
Practice Address - Street 2:STE 250
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1988
Practice Address - Country:US
Practice Address - Phone:898-794-0195
Practice Address - Fax:858-794-0147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05-1647251G00000X
CA051647251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01647FMedicaid
CA05-1647Medicare UPIN