Provider Demographics
NPI:1013599786
Name:GREENLEAF HOSPICE, INC.
Entity Type:Organization
Organization Name:GREENLEAF HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMARIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-221-5124
Mailing Address - Street 1:160 S OLD SPRINGS RD STE 240F
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1260
Mailing Address - Country:US
Mailing Address - Phone:951-221-5124
Mailing Address - Fax:951-498-4096
Practice Address - Street 1:160 S OLD SPRINGS RD STE 240F
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-1260
Practice Address - Country:US
Practice Address - Phone:951-221-5124
Practice Address - Fax:951-498-4096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based