Provider Demographics
NPI:1093997702
Name:ANGEL CITY HOSPICE, INC.
Entity Type:Organization
Organization Name:ANGEL CITY HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONE JADE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-264-1620
Mailing Address - Street 1:4465 S BUFFALO DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-6231
Mailing Address - Country:US
Mailing Address - Phone:702-821-1120
Mailing Address - Fax:
Practice Address - Street 1:4465 S BUFFALO DR
Practice Address - Street 2:SUITE C
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-6231
Practice Address - Country:US
Practice Address - Phone:702-821-1120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based