Provider Demographics
NPI:1316017213
Name:KAISER FOUNDATION HOSPITALS
Entity Type:Organization
Organization Name:KAISER FOUNDATION HOSPITALS
Other - Org Name:KAISER FOUNDATION HOSPITAL HOME HEALTH NOVATO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT, AREA MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-571-4222
Mailing Address - Street 1:7200 REDWOOD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-3250
Mailing Address - Country:US
Mailing Address - Phone:415-893-4132
Mailing Address - Fax:
Practice Address - Street 1:7200 REDWOOD BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-3250
Practice Address - Country:US
Practice Address - Phone:415-893-4132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA010000388251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA557065Medicare Oscar/Certification