Provider Demographics
NPI:1114919099
Name:VNACARE
Entity Type:Organization
Organization Name:VNACARE
Other - Org Name:VNA HOSPICE AND PALLIATIVE CARE OF SOUTHERN CALIFORNIA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:PHN, BSN
Authorized Official - Phone:909-624-3574
Mailing Address - Street 1:2151 E CONVENTION CENTER WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-5449
Mailing Address - Country:US
Mailing Address - Phone:909-624-3574
Mailing Address - Fax:909-624-1559
Practice Address - Street 1:2151 E CONVENTION CENTER WAY STE 100
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-5449
Practice Address - Country:US
Practice Address - Phone:909-624-3574
Practice Address - Fax:909-624-1559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADHS 980000547251E00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01535FMedicaid
CAZZT07008FMedicaid
CA05-1535Medicare ID - Type UnspecifiedHOSPICE
CA05-7008Medicare ID - Type UnspecifiedHOME HEALTH