Provider Demographics
NPI:1043826811
Name:AVIVA HOSPICE, INC.
Entity Type:Organization
Organization Name:AVIVA HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:
Authorized Official - Last Name:PUZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-284-5600
Mailing Address - Street 1:1200 CALIFORNIA ST STE 130
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2946
Mailing Address - Country:US
Mailing Address - Phone:909-284-5600
Mailing Address - Fax:909-284-5602
Practice Address - Street 1:1200 CALIFORNIA ST STE 130
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2946
Practice Address - Country:US
Practice Address - Phone:909-284-5600
Practice Address - Fax:909-284-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-17
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based