Provider Demographics
NPI:1962658369
Name:MAYERS MEMORIAL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:MAYERS MEMORIAL HOSPITAL DISTRICT
Other - Org Name:INTERMOUNTAIN HOSPICE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:REES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-336-5511
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER MILLS
Mailing Address - State:CA
Mailing Address - Zip Code:96028
Mailing Address - Country:US
Mailing Address - Phone:530-336-5511
Mailing Address - Fax:530-336-6199
Practice Address - Street 1:43563 STATE HIGHWAY 299 E
Practice Address - Street 2:
Practice Address - City:FALL RIVER MILLS
Practice Address - State:CA
Practice Address - Zip Code:96028-9787
Practice Address - Country:US
Practice Address - Phone:530-336-5511
Practice Address - Fax:530-336-6996
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAYERS MEMORIAL HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-18
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000021251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01738FOtherMEDI-CAL HOSPICE
051738Medicare Oscar/Certification