Provider Demographics
NPI:1386786150
Name:SILVERADO HOSPICE, INC
Entity type:Organization
Organization Name:SILVERADO HOSPICE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEETSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-240-7200
Mailing Address - Street 1:6400 OAK CANYON
Mailing Address - Street 2:200
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-5233
Mailing Address - Country:US
Mailing Address - Phone:949-240-7200
Mailing Address - Fax:949-930-4014
Practice Address - Street 1:5471 KEARNY VILLA RD STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1141
Practice Address - Country:US
Practice Address - Phone:858-565-1005
Practice Address - Fax:858-565-1063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000553251G00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551522Medicare Oscar/Certification