Provider Demographics
NPI:1205418282
Name:EASTBAY HOSPICE INC
Entity Type:Organization
Organization Name:EASTBAY HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANTILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-290-1816
Mailing Address - Street 1:1710 PENNSYLVANIA AVE STE E-1
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3589
Mailing Address - Country:US
Mailing Address - Phone:707-428-1473
Mailing Address - Fax:707-428-1276
Practice Address - Street 1:1710 PENNSYLVANIA AVE STE E-1
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3589
Practice Address - Country:US
Practice Address - Phone:707-428-1473
Practice Address - Fax:707-428-1276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based