Provider Demographics
NPI:1366449951
Name:SNOWLINE HOSPICE OF EL DORADO COUNTY, INC
Entity Type:Organization
Organization Name:SNOWLINE HOSPICE OF EL DORADO COUNTY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEADOWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-621-7820
Mailing Address - Street 1:6520 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95619-9512
Mailing Address - Country:US
Mailing Address - Phone:530-621-7820
Mailing Address - Fax:530-621-4503
Practice Address - Street 1:6520 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619
Practice Address - Country:US
Practice Address - Phone:530-621-7820
Practice Address - Fax:530-621-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100000610251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC00001FMedicaid
CAHPC00001FMedicaid