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General NPI Number Information
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NPI Number | 1720176316
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Entity Type | Organization
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Legal Business Name | HAZEL HAWKINS MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 01/11/2024
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Provider Practice Location Address
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Address Line | 911 SUNSET DR
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City | HOLLISTER
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State | CA
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Zip | 95023-5606
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Country | US
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Telephone | 831-638-1111
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Fax | 831-638-1728
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Provider Business Mailing Address
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Address Line | 911 SUNSET DR
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City | HOLLISTER
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State | CA
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Zip | 95023-5606
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Country | US
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Telephone | 831-638-1111
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Fax | 831-636-2613
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MARY CASILLAS
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Credential | RN
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Telephone | 831-638-2604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 070000401
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License Number State | CA
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