Provider Demographics
NPI:1124365184
Name:AVON HOSPICE CARE, INC.
Entity Type:Organization
Organization Name:AVON HOSPICE CARE, INC.
Other - Org Name:MANOR HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LULU
Authorized Official - Middle Name:
Authorized Official - Last Name:AQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-481-7579
Mailing Address - Street 1:9007 ARROW RTE STE 180
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4459
Mailing Address - Country:US
Mailing Address - Phone:909-481-7579
Mailing Address - Fax:909-833-7576
Practice Address - Street 1:9007 ARROW RTE STE 180
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4459
Practice Address - Country:US
Practice Address - Phone:909-833-7579
Practice Address - Fax:909-833-7580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550002342251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based