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General NPI Number Information
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NPI Number | 1164544110
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Entity Type | Organization
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Legal Business Name | HICKORY PINE ASSOCIATES
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 50 OAK ST
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City | CAMARILLO
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State | CA
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Zip | 93010-7922
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Country | US
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Telephone | 805-484-1115
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Fax | 805-484-9038
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Provider Business Mailing Address
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Address Line | PO BOX 3141
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City | CAMARILLO
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State | CA
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Zip | 93011-3141
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Country | US
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Telephone | 805-484-1115
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Fax | 508-484-9038
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Authorized Official
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Title or Position | EXEC DIR OPERATIONS
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Name | MRS. AMY LOUISE TRINIDAD
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Credential |
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Telephone | 805-484-1115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State | CA
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