Provider Demographics
NPI:1144243577
Name:HEAVENLY CARE HOSPICE CORP
Entity Type:Organization
Organization Name:HEAVENLY CARE HOSPICE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/TREASURER
Authorized Official - Prefix:MISS
Authorized Official - First Name:FREDA JOY
Authorized Official - Middle Name:VASQUEZ
Authorized Official - Last Name:PRIMICIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-626-4242
Mailing Address - Street 1:4959 PALO VERDE ST STE 106C
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2331
Mailing Address - Country:US
Mailing Address - Phone:909-626-4242
Mailing Address - Fax:909-626-4545
Practice Address - Street 1:4959 PALO VERDE ST STE 106C
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2331
Practice Address - Country:US
Practice Address - Phone:909-626-4242
Practice Address - Fax:909-626-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based