Provider Demographics
NPI:1043711476
Name:ULTRACARE HOSPICE & PALLIATIVE CARE, INC.
Entity Type:Organization
Organization Name:ULTRACARE HOSPICE & PALLIATIVE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-504-5371
Mailing Address - Street 1:970 N TUSTIN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-1761
Mailing Address - Country:US
Mailing Address - Phone:714-603-7613
Mailing Address - Fax:657-208-3780
Practice Address - Street 1:970 N TUSTIN AVE STE 101
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-1761
Practice Address - Country:US
Practice Address - Phone:714-603-7613
Practice Address - Fax:657-208-3780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based