Provider Demographics
NPI:1518205871
Name:TRI VALLEY HOSPICE CARE INC
Entity Type:Organization
Organization Name:TRI VALLEY HOSPICE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JIJY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:818-456-1888
Mailing Address - Street 1:10120 CANOGA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-3005
Mailing Address - Country:US
Mailing Address - Phone:818-456-1888
Mailing Address - Fax:818-456-1257
Practice Address - Street 1:10120 CANOGA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-3005
Practice Address - Country:US
Practice Address - Phone:818-456-1888
Practice Address - Fax:818-456-1257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based