Provider Demographics
NPI:1821166745
Name:OPTIMAL HOSPICE, INC.
Entity Type:Organization
Organization Name:OPTIMAL HOSPICE, INC.
Other - Org Name:BRISTOL HOSPICE - STOCKTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:GERRY
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:014-330-9328
Mailing Address - Street 1:1227 CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-5445
Mailing Address - Country:US
Mailing Address - Phone:661-410-3000
Mailing Address - Fax:661-387-7151
Practice Address - Street 1:2800 W MARCH LN STE 110
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-8220
Practice Address - Country:US
Practice Address - Phone:209-670-8000
Practice Address - Fax:209-670-8020
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTIMAL HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-30
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000173251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01793FMedicaid
CA051793Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER