Provider Demographics
NPI:1003068172
Name:ABRIDGE HOSPICE AND PALLIATIVE CARE LLC
Entity Type:Organization
Organization Name:ABRIDGE HOSPICE AND PALLIATIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADM
Authorized Official - Prefix:MS
Authorized Official - First Name:KELTON
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, CHPN
Authorized Official - Phone:760-643-0400
Mailing Address - Street 1:973 VALE TERRACE DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-5251
Mailing Address - Country:US
Mailing Address - Phone:760-643-0400
Mailing Address - Fax:760-643-0402
Practice Address - Street 1:973 VALE TERRACE DR
Practice Address - Street 2:SUITE 108
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-5251
Practice Address - Country:US
Practice Address - Phone:760-643-0400
Practice Address - Fax:760-643-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000796251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based