Basic Information
| Provider Information | |||||||||
| NPI: | 1831772359 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MISSION HOSPICE & HOME CARE, INC. | ||||||||
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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: | 6505541001 | ||||||||
| Practice Location | |||||||||
| Address1: | 66 BOVET RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944023126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505541000 | ||||||||
| FaxNumber: | 6505541001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2021 | ||||||||
| LastUpdateDate: | 07/15/2022 | ||||||||
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| AuthorizedOfficialLastName: | IGNACIO | ||||||||
| AuthorizedOfficialFirstName: | ALEX | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF ADMINISTRATIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6505541000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 07/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | N | Agencies | Home Health | 207RH0002X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 051665 | 05 | CA | MEDICAID | CA502834 | 05 | CA | MEDICAID |