Provider Demographics
NPI:1174017206
Name:OPULENCE HOSPICE CARE,INC
Entity Type:Organization
Organization Name:OPULENCE HOSPICE CARE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOU MIZELLE
Authorized Official - Middle Name:DELACRUZ
Authorized Official - Last Name:TANWANGCO
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIAN ASSISTANT
Authorized Official - Phone:951-486-9179
Mailing Address - Street 1:12085 HEACOCK ST
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-7102
Mailing Address - Country:US
Mailing Address - Phone:951-486-9179
Mailing Address - Fax:951-486-9529
Practice Address - Street 1:12085 HEACOCK ST
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-7102
Practice Address - Country:US
Practice Address - Phone:951-486-9179
Practice Address - Fax:951-486-9529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based