Hospice Service of Lake County

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

100000734 Issued in CA

Legal business name

HOSPICE SERVICE OF LAKE COUNTY

Practice address

1862 Parallel Dr
Lakeport, CA 95453

Phone

(707) 263-6222

Fax

(707) 263-4045

NPI assigned

Jul 1, 2005

Organization subpart

No

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

Authorized official

Name

Theresa L Phelps

Title

Director of Quality and Compliance

Phone

(707) 263-6222

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Hospice certification: CCN 051561

Legal name

HOSPICE SERVICE OF LAKE COUNTY

Certification status

Active

Provider type (POS)

Hospice

Participating since

Dec 12, 1989

Last certification

Mar 24, 2021

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationNon-profit

Incorporated

Jun 19, 1980 in CA

Enrollment address

1862 Parallel Dr
Lakeport, CA 95453-9388

Listed as

Hospice Services of Lake CountyCCN 051561 · All quality measures

Ownership

For-Profit

Certified

Dec 12, 1989

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 5

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

Owners & managing parties with NPI records 1

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

• Kirk G Andrus, MD

  • Family Medicine Physician
  • Kelseyville, CA
  • NPI 1699789891

  Contracted Managing Employee, Corporate Director

  CMS ownership

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kirk G Andrus, MD

  • Family Medicine Physician
  • Kelseyville, CA
  • NPI 1699789891
  Medicare reassignment NPD

Affiliated clinicians 1

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

• Rajeev Reddy Malireddy, MD

  • Hospitalist Physician
  • Kalamazoo, MI
  • NPI 1467884775

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770336000000",
    "number": "1801893177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1862 PARALLEL DR",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954539388",
            "telephone_number": "707-263-6222",
            "fax_number": "707-263-4045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1862 PARALLEL DR",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "95453",
            "telephone_number": "707-263-6222",
            "fax_number": "707-263-4045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPICE SERVICE OF LAKE COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-01",
        "last_updated": "2026-02-06",
        "certification_date": "2026-02-06",
        "status": "A",
        "authorized_official_last_name": "PHELPS",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DIRECTOR OF QUALITY AND COMPLIANCE",
        "authorized_official_telephone_number": "707-263-6222"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "CA",
            "license": "100000734",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HPC01561F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Courtne Hill
• Carolyn Jean Holladay, RN, PHN
• Kerry John Hollenbeck, M.D.
• Home With US, LLC
• Kevin Q. Hong
• Patricia Hubbard
• Lannette R Huffman, DDS
• Lan Kim Huynh
• Integrated Dermatology of Lakeport, PC
• Intuimind Individual and Couples Counseling Inc.

• Community Based Hospice Care Agency in Lakeport, CA
• Providers in Lakeport, CA by specialty
• Community Based Hospice Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.