Provider Demographics
NPI:1083207468
Name:SOUTHERN CALIFORNIA HOSPICE CARE
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA HOSPICE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:505-659-1320
Mailing Address - Street 1:285 RILEY RD
Mailing Address - Street 2:
Mailing Address - City:ESTANCIA
Mailing Address - State:NM
Mailing Address - Zip Code:87016-7909
Mailing Address - Country:US
Mailing Address - Phone:505-659-1320
Mailing Address - Fax:
Practice Address - Street 1:32364 KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-1825
Practice Address - Country:US
Practice Address - Phone:505-659-1320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based