MEDICARE: SUNCREST HOSPICE SAN JOSE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1124368808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNCREST HOSPICE SAN JOSE LLC

Provider Business Mailing Address
First Line	:	9800 S MONROE ST STE 809
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-4419
Country	:	US
Telephone Number	:	801-849-0486
Fax Number	:	801-849-0476

Provider Business Practice Location Address
First Line	:	3215 SKYWAY CT
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94539-5951
Country	:	US
Telephone Number	:	408-900-8838
Fax Number	:

Authorized Official
Title or Position	:	PARALEGAL
Name	:	SARAH EILEEN NIELSEN
Credential	:
Telephone Number	:	435-610-2285

Provider Enumeration Date	:	02/18/2013
Last Update Date	:	07/31/2024

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