Provider Demographics
NPI:1386636397
Name:HOSPICE OF THE VALLEY
Entity Type:Organization
Organization Name:HOSPICE OF THE VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ADELUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-559-5600
Mailing Address - Street 1:4850 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-5156
Mailing Address - Country:US
Mailing Address - Phone:408-559-5600
Mailing Address - Fax:408-559-5320
Practice Address - Street 1:4850 UNION AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-5156
Practice Address - Country:US
Practice Address - Phone:408-559-5600
Practice Address - Fax:408-559-3520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000396163WH1000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community Based
No163WH1000XNursing Service ProvidersRegistered NurseHospiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01507FMedicaid
CA1386636397Medicaid
CA05-1507Medicare ID - Type Unspecified