Provider Demographics
NPI:1043886708
Name:THEIA HOSPICE AND PALLIATIVE CARE, INC.
Entity Type:Organization
Organization Name:THEIA HOSPICE AND PALLIATIVE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HURTADO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:626-675-9557
Mailing Address - Street 1:363 S PARK AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-1560
Mailing Address - Country:US
Mailing Address - Phone:909-780-1150
Mailing Address - Fax:909-780-1151
Practice Address - Street 1:363 S PARK AVE STE 206
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-1560
Practice Address - Country:US
Practice Address - Phone:909-780-1150
Practice Address - Fax:909-780-1151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based