Provider Demographics
NPI:1023414349
Name:CHARTER HOSPICE OF SAN DIEGO, LLC
Entity type:Organization
Organization Name:CHARTER HOSPICE OF SAN DIEGO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-644-4965
Mailing Address - Street 1:16955 VIA DEL CAMPO STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1719
Mailing Address - Country:US
Mailing Address - Phone:760-414-9717
Mailing Address - Fax:760-414-9095
Practice Address - Street 1:840 TOWNSITE DR
Practice Address - Street 2:STE. 856
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-5566
Practice Address - Country:US
Practice Address - Phone:760-414-9717
Practice Address - Fax:760-414-9095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based