Healthcare Provider Details

I. General information

NPI: 1043353196
Provider Name (Legal Business Name): VITAS HEALTHCARE CORPORATION CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 LAKEVILLE HWY SUITE 205
PETALUMA CA
94954-5671
US

IV. Provider business mailing address

100 S BISCAYNE BLVD SUITE 1500
MIAMI FL
33131-2011
US

V. Phone/Fax

Practice location:
  • Phone: 707-787-2200
  • Fax: 707-787-2250
Mailing address:
  • Phone: 305-374-4143
  • Fax: 305-350-6784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number100000781
License Number StateCA

VIII. Authorized Official

Name: DEIRDRE LAWE
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 305-350-6925