NPIMap

Organization Active NPI

St. Joseph Home Care Network

Doing business as Providence Hospice Sonoma County

  • Community Based Hospice Care Agency
  • Petaluma, CA
National Provider Identifier
1174065809
Registry record updated May 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
ST. JOSEPH HOME CARE NETWORK
Doing business as
Providence Hospice Sonoma County
Practice address
416 Payran St
Petaluma, CA 94952-5907
Phone
(707) 778-6242
Fax
(707) 778-0144
NPI assigned
Nov 11, 2016
Last updated
May 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Donald W Anderson Jr.
Title
Assistant Secretary for Enrollment
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X CA Primary

Addresses

Primary practice location

416 Payran St
Petaluma, CA 94952-5907

Mailing address

PO Box 31001-1986
Pasadena, CA 91110-1986

Other names 1

  • Providence Hospice Sonoma County Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20171004002045 CA Part A Provider - Hospice 2860477403 Practice locations: Santa Rosa, CA; Petaluma, CA
O20210203002973 CA Part B Supplier - Clinic/Group Practice 2860477403 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Santa Rosa, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174065809. Details of each certification follow.

Hospice certification: CCN 051557

Legal name
ST JOSEPH HOME CARE NETWORK
Doing business as
PROVIDENCE HOSPICE SONOMA COUNTY
Certification status
Active
Provider type (POS)
Hospice
Participating since
Aug 10, 1989
Last certification
Apr 12, 2017
Ownership / control type
Non-Profit - Church
Most recent change of ownership
Sep 29, 2025
Organization structure
CorporationNon-profit
Incorporated
Apr 19, 1994 in CA
Enrollment address
416 Payran St
Petaluma, CA 94952-5907

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospice

Medicare Care Compare
Listed as
Providence at Home With Compassus Hospice Care, Sonoma CountyCCN 051557 · All quality measures
Ownership
Non-Profit
Certified
Aug 10, 1989
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
St Joseph Home Care Network5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1131 Main St
Fortuna, CA 95540
Phone (707) 725-3389

205 East St
Healdsburg, CA 95448
Phone (707) 431-1135

2700 Napa Valley Corporate Dr
Ste C
Napa, CA 94558
Phone (707) 257-4124

170 Professional Center Dr
Ste B
Rohnert Park, CA 94928
Phone (707) 206-9124

1111 Sonoma Ave
Ste 308
Santa Rosa, CA 95405
Phone (707) 206-9124

441 College Ave
Santa Rosa, CA 95401
Phone (707) 206-9124

Ownership & related parties

All disclosed owners & managing parties 20

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Dwight Story Fullerton Individual Corporate DirectorBoard Member Mar 2, 2021
Paul Edward Swafford Individual Corporate DirectorBoard Member Mar 4, 2022
Terri P Warren Individual Corporate OfficerPresident/Ceo Apr 13, 2023
Providence Health & Services - Washington Organization, Renton, WA Corporation, Non-profit Operational/Managerial Control Jul 1, 2016
Janice Burger Individual Corporate Director Dec 28, 2021
Terry Rogers Individual Corporate DirectorBoard Member Mar 2, 2021
Robert McCann Individual Corporate DirectorBoard Member Mar 2, 2021
Kateri Murray Individual Contracted Managing Employee May 1, 2023
Jody Albright Individual Corporate DirectorBoard Member Mar 2, 2021
Nicole Sikes Individual W-2 Managing EmployeeDirector Aug 22, 2022
Malisa J Westlund Individual Corporate OfficerTreasurer/Cfo Jan 3, 2022
James Zapp Individual Corporate DirectorBoard Member Mar 2, 2021
Larry Schecter Individual Corporate DirectorBoard Member Mar 2, 2021
Dianna Reely Individual Corporate DirectorBoard Member Apr 13, 2023
Donald Wayne Anderson Individual Corporate OfficerAssistant Secretary for Enrollment Jan 1, 2017
Gregory David Hoffman Individual Corporate OfficerEvp/Cfe Oct 1, 2020
St. Joseph Health System Organization, Irvine, CA Corporation, Non-profit Other Mar 8, 2017
Rachel Arrington Individual Corporate OfficerCorporate Secretary Apr 13, 2023
Shayna Stiles Individual W-2 Managing EmployeeAdministrator Nov 1, 2022
St Joseph Health Northern California LLC Organization, Irvine, CA LLC, Non-profit 5% Or Greater Direct Ownership Interest Apr 1, 2018 100%

Owners & managing parties with NPI records 10

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Providence Hospice Napa ValleyNapa, CA, CCN 051537 Hospice Other Jun 1, 2020

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Collabria Care

    dba Providence Palliative Care Napa Valley

    • Community Based Hospice Care Agency
    • Napa, CA
    • NPI 1023011178

    Other

    CMS ownership

Facilities with the same owner 139

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 139

Change-of-ownership history 1

DateEventCounterparty
Oct 1, 2017 Change of OwnershipThis provider was the buyer Hospice of PetalumaCCN 051557, CA, NPI 1790770188

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1478822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747353600000",
    "number": "1174065809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-1986",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911101986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 PAYRAN ST",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949525907",
            "telephone_number": "707-778-6242",
            "fax_number": "707-778-0144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOSEPH HOME CARE NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-11",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY FOR ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Hospice Sonoma County",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Hospice Sonoma County",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Petaluma, CA

Sources for this page

Verify at the official NPI Registry.