Provider Demographics
NPI:1295951622
Name:HOSPICE CARE OF THE VALLEY, INC
Entity type:Organization
Organization Name:HOSPICE CARE OF THE VALLEY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMAGUILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-520-7055
Mailing Address - Street 1:1176 ROADRUNNER WAY
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-3158
Mailing Address - Country:US
Mailing Address - Phone:805-520-7055
Mailing Address - Fax:805-520-3955
Practice Address - Street 1:1176 ROADRUNNER WAY
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-3158
Practice Address - Country:US
Practice Address - Phone:805-520-7055
Practice Address - Fax:805-520-3955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000186251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC51503FMedicaid
CA551503Medicare Oscar/Certification