NPIMap

Organization Active NPI

Hospice of Humboldt Inc

  • Community Based Hospice Care Agency
  • Eureka, CA
National Provider Identifier
1619015393
Registry record updated Aug 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
HOSPICE OF HUMBOLDT INC
Practice address
3327 Timber Fall CT
Eureka, CA 95503-4894
Phone
(707) 445-8443
Fax
(707) 445-2209
NPI assigned
Feb 2, 2007
Last updated
Aug 19, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2015

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

Authorized official

Name
Mr. Joseph J Rogers
Title
Executive Director
Phone
(707) 441-0105

Specialties & licenses 1

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

Addresses

Primary practice location

3327 Timber Fall CT
Eureka, CA 95503-4894

Mailing address

3327 Timber Fall CT
Eureka, CA 95503-4894
Phone (707) 445-8443

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20111123000569 CA Part A Provider - Hospice 5193999415 Practice locations: Eureka, CA
O20181107001488 CA Part B Supplier - Clinic/Group Practice 5193999415 Receives reassigned benefits from 6 practitioners
Practice locations: Eureka, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619015393. Details of each certification follow.

Hospice certification: CCN 051536

Legal name
HOSPICE OF HUMBOLDT, INC.
Certification status
Active
Provider type (POS)
Hospice
Participating since
Feb 25, 1988
Last certification
Jun 29, 2017
Ownership / control type
Other
Organization structure
CorporationNon-profit
Enrollment address
3327 Timber Fall CT
Eureka, CA 95503-4894

Care Compare: Hospice

Medicare Care Compare
Listed as
Hospice of Humboldt, Inc.CCN 051536 · All quality measures
Ownership
Non-Profit
Certified
Feb 25, 1988
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Hospice of Humboldt Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

2010 Myrtle Ave
Eureka, CA 95501
Phone (707) 445-8443

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Dianne K Vallee Individual Corporate DirectorCeo Jul 1, 2022 100%
W-2 Managing EmployeeAd; Feb 2, 2012
Alannah Smith Individual Corporate OfficerBoard Member Apr 14, 2020 5%
Sarah Shanahan Individual W-2 Managing EmployeeDirector of Human Resources Nov 9, 2015 5%
Jim Bella Individual Corporate OfficerBoard Member, Treasurer Apr 1, 2025 5%
Lisa Kay Parris Individual W-2 Managing EmployeeDirector of Quality and Compliance Jan 6, 2025 5%
Stacy Watkins Individual Corporate OfficerBoard Member Apr 14, 2020 5%
Charles Irving Knoll Individual W-2 Managing EmployeeMD; Dec 1, 2025 5%
Tracy Craig Individual W-2 Managing EmployeeDirector of Patient Care Services Jan 1, 2025 5%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 6

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 3

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": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439942400000",
    "number": "1619015393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3327 TIMBER FALL CT",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955034894",
            "telephone_number": "707-445-8443",
            "fax_number": "707-445-2209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3327 TIMBER FALL CT",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955034894",
            "telephone_number": "707-445-8443",
            "fax_number": "707-445-2209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPICE OF HUMBOLDT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2015-08-19",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "707-441-0105",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eureka, CA

Sources for this page

Verify at the official NPI Registry.