Provider Demographics
NPI:1124674387
Name:HOSPICIO DE SAN MIGUEL INC
Entity type:Organization
Organization Name:HOSPICIO DE SAN MIGUEL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:DELEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-861-8705
Mailing Address - Street 1:24301 SOUTHLAND DR STE 618
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-1555
Mailing Address - Country:US
Mailing Address - Phone:510-455-4540
Mailing Address - Fax:510-397-0491
Practice Address - Street 1:24301 SOUTHLAND DR STE 618
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-1555
Practice Address - Country:US
Practice Address - Phone:510-455-4540
Practice Address - Fax:510-397-0491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based