Provider Demographics
NPI:1891327573
Name:ADYA HOSPICE & PALLIATIVE CARE, LLC
Entity Type:Organization
Organization Name:ADYA HOSPICE & PALLIATIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT BRYAN
Authorized Official - Middle Name:VICENCIO
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:650-922-3707
Mailing Address - Street 1:1652 W TEXAS ST STE 207
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6080
Mailing Address - Country:US
Mailing Address - Phone:707-200-2989
Mailing Address - Fax:707-306-7720
Practice Address - Street 1:1652 W TEXAS ST STE 207
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6080
Practice Address - Country:US
Practice Address - Phone:707-200-2989
Practice Address - Fax:707-306-7720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based