Provider Demographics
NPI:1093082281
Name:ANGELS ON EARTH HOSPICE
Entity Type:Organization
Organization Name:ANGELS ON EARTH HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DPCS
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:CHAINGAN
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:626-252-7455
Mailing Address - Street 1:4959 PALO VERDE ST
Mailing Address - Street 2:STE 202-A
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2331
Mailing Address - Country:US
Mailing Address - Phone:909-626-8802
Mailing Address - Fax:909-626-8812
Practice Address - Street 1:4959 PALO VERDE ST
Practice Address - Street 2:STE 202-A
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2331
Practice Address - Country:US
Practice Address - Phone:909-626-8802
Practice Address - Fax:909-626-8812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based