Provider Demographics
NPI:1356674204
Name:SAN DIEGO HOSPICE & THE INSTITUTE OF PALLIATIVE MEDICINE
Entity Type:Organization
Organization Name:SAN DIEGO HOSPICE & THE INSTITUTE OF PALLIATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-688-1600
Mailing Address - Street 1:4311 THIRD AVE.
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1407
Mailing Address - Country:US
Mailing Address - Phone:619-688-1600
Mailing Address - Fax:619-688-0734
Practice Address - Street 1:4311 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1407
Practice Address - Country:US
Practice Address - Phone:619-688-1600
Practice Address - Fax:619-688-0734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000516251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA70013FMedicaid
CAHHA70013FMedicaid