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General NPI Number Information
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NPI Number | 1619511508
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Entity Type | Organization
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Legal Business Name | ALEXA HOSPICE INC.
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Dates
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Enumeration Date | 11/04/2019
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Last Update Date | 11/04/2019
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Provider Practice Location Address
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Address Line | 14895 E 14TH ST STE 300
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City | SAN LEANDRO
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State | CA
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Zip | 94578-2927
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Country | US
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Telephone | 510-877-0055
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Fax |
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Provider Business Mailing Address
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Address Line | 14895 E 14TH ST STE 300
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City | SAN LEANDRO
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State | CA
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Zip | 94578-2927
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Country | US
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Telephone | 510-877-0055
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. MICHAEL ANGEL CAMPO DERLA
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Credential |
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Telephone | 510-877-0055
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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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