Provider Demographics
NPI:1164967741
Name:CHERRY BLOSSOM HEALTHCARE PALLIATIVE & HOSPICE, INC.
Entity Type:Organization
Organization Name:CHERRY BLOSSOM HEALTHCARE PALLIATIVE & HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LORENZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:323-236-0872
Mailing Address - Street 1:688 N ARROWHEAD AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401-1171
Mailing Address - Country:US
Mailing Address - Phone:909-999-5436
Mailing Address - Fax:
Practice Address - Street 1:688 N ARROWHEAD AVE
Practice Address - Street 2:STE 205
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1171
Practice Address - Country:US
Practice Address - Phone:909-999-5436
Practice Address - Fax:888-752-8950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA608-15-9853Medicaid