Provider Demographics
NPI:1497811012
Name:TAHOE FOREST HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:TAHOE FOREST HOSPITAL DISTRICT
Other - Org Name:TAHOE FOREST HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-582-6656
Mailing Address - Street 1:10083 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-4826
Mailing Address - Country:US
Mailing Address - Phone:530-582-3534
Mailing Address - Fax:
Practice Address - Street 1:10083 LAKE AVE
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4826
Practice Address - Country:US
Practice Address - Phone:530-582-3534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10000755251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-1732Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER