Provider Demographics
NPI:1689189110
Name:COLUSA MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:COLUSA MEDICAL CENTER, LLC
Other - Org Name:PROGRESSIVE HOSPICE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-248-7851
Mailing Address - Street 1:700 17TH ST STE 201D
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1249
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:199 E WEBSTER ST
Practice Address - Street 2:
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932-2954
Practice Address - Country:US
Practice Address - Phone:530-619-0800
Practice Address - Fax:530-619-0897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient