MEDICARE: HOSPICE OF AMADOR & CALAVERAS

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235111097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE OF AMADOR & CALAVERAS

Provider Business Mailing Address
First Line	:	PO BOX 595
Second Line	:
City	:	JACKSON
State	:	CA
Zip	:	95642-0595
Country	:	US
Telephone Number	:	209-223-5500
Fax Number	:	209-223-3752

Provider Business Practice Location Address
First Line	:	1500 S STATE HIGHWAY 49
Second Line	:	SUITE 205
City	:	JACKSON
State	:	CA
Zip	:	95642-2652
Country	:	US
Telephone Number	:	209-223-5500
Fax Number	:	209-223-3752

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. DAN J RIORDAN
Credential	:
Telephone Number	:	209-223-5500

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	06/09/2008

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