Provider Demographics
NPI:1366842684
Name:SONORAN WINDS HOSPICE, INC
Entity Type:Organization
Organization Name:SONORAN WINDS HOSPICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-523-5030
Mailing Address - Street 1:6131 ORANGETHORPE AVE
Mailing Address - Street 2:SUITE 180
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-1315
Mailing Address - Country:US
Mailing Address - Phone:714-523-5030
Mailing Address - Fax:714-523-5060
Practice Address - Street 1:6131 ORANGETHORPE AVE STE 180
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4901
Practice Address - Country:US
Practice Address - Phone:714-523-5030
Practice Address - Fax:714-523-5060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000234251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55-1555OtherMEDICARE PROVIDER NUMBER
CA550000234OtherMEDI-CAL