NPIMap

Organization Active NPI

Hazel Hawkins Memorial Hospital

Doing business as Hazel Hawkins Conv. Hospital

  • Skilled Nursing Facility
  • Hollister, CA
National Provider Identifier
1467585471
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
070000004 Issued in CA
Legal business name
HAZEL HAWKINS MEMORIAL HOSPITAL
Doing business as
Hazel Hawkins Conv. Hospital
Practice address
911 Sunset Dr
Hollister, CA 95023-5602
Phone
(831) 637-5711
Fax
(831) 637-3126
NPI assigned
Mar 13, 2007
Last updated
Jan 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2024

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

Authorized official

Name
Mrs. Mary Casillas
Title
Chief Financial Officer
Phone
(831) 636-2604

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 070000004 CA Primary

Addresses

Primary practice location

911 Sunset Dr
Hollister, CA 95023-5602

Mailing address

911 Sunset Dr
Hollister, CA 95023-5602
Phone (831) 637-5711

Other identifiers 1

IdentifierTypeStateIssuer
ZZR05462FMedicaidCA

Other names 1

  • HAZEL HAWKINS CONV. HOSPITAL Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100330000537 CA Part A Provider - Skilled Nursing Facility 9133038326 Practice locations: Hollister, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467585471. Details of each certification follow.

Skilled nursing facility certification: CCN 055462

Legal name
HAZEL HAWKINS MEMORIAL HOSPITAL
Doing business as
HAZEL HAWKINS CONV HOSPITAL
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Jul 1, 1968
Last certification
Mar 19, 2024
Beds
119
Ownership / control type
Hospital District
Organization structure
OtherNon-profit
Enrollment address
900 Sunset Dr
Hollister, CA 95023-5603
Nursing home name
HAZEL HAWKINS MEMORIAL HOSPITAL D/P SNF

Other NPIs with the same Medicare PAC ID 7

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Hazel Hawkins Memorial Hospital D/P SNFCCN 055462 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
5 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Government - Hospital district
Certified
Jul 1, 1968
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
11990.0 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Hazel Hawkins HSP Rad D10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

900 Sunset Dr
Hollister, CA 95023
Phone (831) 635-1106

911 Sunset Dr
#5462F
Hollister, CA 95023

911A Sunset Dr
Hollister, CA 95023

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Jerrianne M Hernandez Individual Corporate DirectorBoard Member Nov 1, 2016
Ariel M Hurtado Individual Corporate DirectorBoard Member Nov 16, 2016
Josefa Sanchez Individual Corporate DirectorBoard Member Nov 1, 2014
Kenneth S Underwood Individual Corporate OfficerCeo May 1, 2000 100%
Angelina de Lacruz Individual Corporate DirectorBoard Member Nov 16, 2016
Mark T Robinson Individual Operational/Managerial Control Feb 19, 2001

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Mabie First Street Healthcare CenterHollister, CA, CCN 058660 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2012
Barragan Family Health Care and Diabetes CenterHollister, CA, CCN 058705 Rural health clinic Operational/Managerial Control (100%) Dec 15, 2005

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1467585471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 SUNSET DR",
            "city": "HOLLISTER",
            "state": "CA",
            "postal_code": "950235602",
            "telephone_number": "831-637-5711",
            "fax_number": "831-637-3126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 SUNSET DR",
            "city": "HOLLISTER",
            "state": "CA",
            "postal_code": "950235602",
            "telephone_number": "831-637-5711",
            "fax_number": "831-637-3126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAZEL HAWKINS MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A",
        "authorized_official_last_name": "CASILLAS",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "831-636-2604",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "070000004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZR05462F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HAZEL HAWKINS CONV. HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HAZEL HAWKINS CONV. HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hollister, CA

Sources for this page

Verify at the official NPI Registry.