Provider Demographics
NPI:1235111097
Name:HOSPICE OF AMADOR & CALAVERAS
Entity Type:Organization
Organization Name:HOSPICE OF AMADOR & CALAVERAS
Other - Org Name:HOSPICE OF AMADOR
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-223-5500
Mailing Address - Street 1:PO BOX 595
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-0595
Mailing Address - Country:US
Mailing Address - Phone:209-223-5500
Mailing Address - Fax:209-223-3752
Practice Address - Street 1:1500 S STATE HIGHWAY 49
Practice Address - Street 2:SUITE 205
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2652
Practice Address - Country:US
Practice Address - Phone:209-223-5500
Practice Address - Fax:209-223-3752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01650FMedicaid
CAHPC01650FMedicaid