Provider Demographics
NPI:1083211700
Name:ARCHIBALD HOSPICE INC
Entity Type:Organization
Organization Name:ARCHIBALD HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:YBARDOLAZA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:909-732-5732
Mailing Address - Street 1:9221 ARCHIBALD AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5207
Mailing Address - Country:US
Mailing Address - Phone:909-732-5732
Mailing Address - Fax:
Practice Address - Street 1:9221 ARCHIBALD AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5207
Practice Address - Country:US
Practice Address - Phone:909-732-5732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based