Provider Demographics
NPI:1649521675
Name:DATURA HOSPICE, INC.
Entity type:Organization
Organization Name:DATURA HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ART
Authorized Official - Middle Name:
Authorized Official - Last Name:MAROUTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-664-9948
Mailing Address - Street 1:2060 WALSH AVE
Mailing Address - Street 2:242
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-2500
Mailing Address - Country:US
Mailing Address - Phone:888-664-9948
Mailing Address - Fax:
Practice Address - Street 1:2060 WALSH AVE.
Practice Address - Street 2:242
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-2559
Practice Address - Country:US
Practice Address - Phone:888-664-9948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based