Provider Demographics
NPI:1669141537
Name:SEASIDE HOSPICE LLC
Entity type:Organization
Organization Name:SEASIDE HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DUY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-818-2497
Mailing Address - Street 1:735 ABBYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-6902
Mailing Address - Country:US
Mailing Address - Phone:714-818-2497
Mailing Address - Fax:
Practice Address - Street 1:3907 OCEANIC DR STE 301
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-5852
Practice Address - Country:US
Practice Address - Phone:714-818-2497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based