Basic Information
| Provider Information | |||||||||
| NPI: | 1396754115 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MISSION HOSPICE & HOME CARE, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MISSION HOSPICE OF SAN MATEO COUNTY | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 BOVET RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944023126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505541000 | ||||||||
| FaxNumber: | 6505541018 | ||||||||
| Practice Location | |||||||||
| Address1: | 66 BOVET ROAD SUITE 100 | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944023126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505541000 | ||||||||
| FaxNumber: | 6505541018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 07/15/2022 | ||||||||
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| AuthorizedOfficialLastName: | IGNACIO | ||||||||
| AuthorizedOfficialFirstName: | ALEX | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF ADMINISTRATIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6505541000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 0700584 | CA | N | Agencies | Hospice Care, Community Based | 251G00000X | 0700000584 | CA | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | CA502834 | 05 | CA | MEDICAID | 051665 | 05 | CA | MEDICAID |