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General NPI Number Information
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NPI Number | 1124205067
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Entity Type | Organization
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Legal Business Name | KELLI A. FOX
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 1230 W BALBOA BLVD #E
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City | NEWPORT BEACH
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State | CA
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Zip | 92661-1061
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Country | US
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Telephone | 801-451-9020
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Fax | 866-299-5156
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Provider Business Mailing Address
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Address Line | 1230 W BALBOA BLVD #E
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City | NEWPORT BEACH
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State | CA
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Zip | 92661-1061
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Country | US
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Telephone | 801-451-9020
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Fax | 866-299-5156
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. KELLI ANN FOX
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Credential |
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Telephone | 801-451-9020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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