Provider Demographics
NPI:1396754115
Name:MISSION HOSPICE & HOME CARE, INC.
Entity type:Organization
Organization Name:MISSION HOSPICE & HOME CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:IGNACIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-554-1000
Mailing Address - Street 1:66 BOVET RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3126
Mailing Address - Country:US
Mailing Address - Phone:650-554-1000
Mailing Address - Fax:650-554-1018
Practice Address - Street 1:66 BOVET ROAD SUITE 100
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3126
Practice Address - Country:US
Practice Address - Phone:650-554-1000
Practice Address - Fax:650-554-1018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0700584251G00000X
CA0700000584251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA502834Medicaid
CA051665Medicaid
CA051665Medicare Oscar/Certification