Provider Demographics
NPI:1033661533
Name:SOUVENIR HOSPICE AND PALLIATIVE CARE, INC.
Entity Type:Organization
Organization Name:SOUVENIR HOSPICE AND PALLIATIVE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:UKEJE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELENDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-363-3325
Mailing Address - Street 1:750 ALFRED NOBEL DR STE 204
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1836
Mailing Address - Country:US
Mailing Address - Phone:844-363-3325
Mailing Address - Fax:916-914-2134
Practice Address - Street 1:1451 RIVER PARK DR STE 222
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4521
Practice Address - Country:US
Practice Address - Phone:844-363-3325
Practice Address - Fax:916-914-2134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550003260251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based