Provider Demographics
NPI:1629118898
Name:HOSPICE OF ST. MARY INC.
Entity Type:Organization
Organization Name:HOSPICE OF ST. MARY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZILFINYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-306-0440
Mailing Address - Street 1:1985 YOSEMITE AVE
Mailing Address - Street 2:STE 240
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-5234
Mailing Address - Country:US
Mailing Address - Phone:805-306-0440
Mailing Address - Fax:805-306-0880
Practice Address - Street 1:1985 YOSEMITE AVE
Practice Address - Street 2:STE 240
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-5234
Practice Address - Country:US
Practice Address - Phone:818-389-2130
Practice Address - Fax:805-306-0880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000056251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551509Medicare Oscar/Certification