Provider Demographics
NPI:1275578817
Name:HAZEL HAWKINS MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:HAZEL HAWKINS MEMORIAL HOSPITAL
Other - Org Name:SAN BENITO HEALTH CARE DISTRICT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASILLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-636-2604
Mailing Address - Street 1:911 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5602
Mailing Address - Country:US
Mailing Address - Phone:831-637-5711
Mailing Address - Fax:831-637-3126
Practice Address - Street 1:911 SUNSET DR
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5602
Practice Address - Country:US
Practice Address - Phone:831-637-5711
Practice Address - Fax:831-637-3126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000004282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP40296FMedicaid
CAZZR00296FMedicaid
CAHSP40296FMedicaid
CAZZR00296FMedicaid