Provider Demographics
NPI:1467443952
Name:YOLO HOSPICE, INC.
Entity Type:Organization
Organization Name:YOLO HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:DRESANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-758-5566
Mailing Address - Street 1:PO BOX 1014
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95617-1014
Mailing Address - Country:US
Mailing Address - Phone:530-758-5566
Mailing Address - Fax:530-758-8502
Practice Address - Street 1:1909 GALILEO CT
Practice Address - Street 2:SUITE A
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-4890
Practice Address - Country:US
Practice Address - Phone:530-758-5566
Practice Address - Fax:530-758-8502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA030000556251G00000X
CA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01619FMedicaid
CA05-1619Medicare ID - Type UnspecifiedCMS HOSPICE #