Provider Demographics
NPI:1043628217
Name:FOOTHILL HOSPICE CARE INC
Entity Type:Organization
Organization Name:FOOTHILL HOSPICE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ROZA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVITIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-919-2535
Mailing Address - Street 1:222 N MOUNTAIN AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5745
Mailing Address - Country:US
Mailing Address - Phone:909-919-2535
Mailing Address - Fax:909-919-2574
Practice Address - Street 1:222 N MOUNTAIN AVE STE 207
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5745
Practice Address - Country:US
Practice Address - Phone:909-919-2535
Practice Address - Fax:909-919-2574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based