Provider Demographics
NPI:1134687833
Name:MONTCLAIR HORIZON HOSPICE, INC.
Entity Type:Organization
Organization Name:MONTCLAIR HORIZON HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GIO
Authorized Official - Middle Name:ALPHONSO
Authorized Official - Last Name:PISCACIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-999-8835
Mailing Address - Street 1:4708 BROOKS ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-4723
Mailing Address - Country:US
Mailing Address - Phone:909-999-8835
Mailing Address - Fax:
Practice Address - Street 1:4708 BROOKS ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-4723
Practice Address - Country:US
Practice Address - Phone:909-999-8835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based