Provider Demographics
NPI:1366646671
Name:MADRONE HOSPICE, INC.
Entity Type:Organization
Organization Name:MADRONE HOSPICE, INC.
Other - Org Name:MADRONE ADULT HEALTHCARE
Other - Org Type:Other Name
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 1:210 W CENTER ST
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-2907
Practice Address - Country:US
Practice Address - Phone:530-842-3466
Practice Address - Fax:530-842-3588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70280FMedicaid