Provider Demographics
NPI:1275608614
Name:MADRONE HOSPICE, INC
Entity Type:Organization
Organization Name:MADRONE HOSPICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-842-3160
Mailing Address - Street 1:255 COLLIER CIR
Mailing Address - Street 2:
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097-2276
Mailing Address - Country:US
Mailing Address - Phone:530-842-3160
Mailing Address - Fax:530-842-6412
Practice Address - Street 1:255 COLLIER CIR
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-2276
Practice Address - Country:US
Practice Address - Phone:530-842-3160
Practice Address - Fax:530-842-6412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01657FMedicaid
CAHPC01657FMedicaid