MEDICARE: HAZEL HAWKINS MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1588804819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAZEL HAWKINS MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	911 SUNSET DR
Second Line	:
City	:	HOLLISTER
State	:	CA
Zip	:	95023-5606
Country	:	US
Telephone Number	:	831-636-2626
Fax Number	:	831-636-3718

Provider Business Practice Location Address
First Line	:	991 4TH ST
Second Line	:
City	:	HOLLISTER
State	:	CA
Zip	:	95023-3643
Country	:	US
Telephone Number	:	831-636-2626
Fax Number	:	831-637-3126

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MRS. MARY CASILLAS
Credential	:
Telephone Number	:	831-636-2604

Provider Enumeration Date	:	02/26/2009
Last Update Date	:	01/11/2024

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