Provider Demographics
NPI:1194361964
Name:CREATIVE HOSPICE CARE INC
Entity Type:Organization
Organization Name:CREATIVE HOSPICE CARE INC
Other - Org Name:CALSTRO HOSPICE LOS ANGELES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-643-6250
Mailing Address - Street 1:430 S GARFIELD AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3876
Mailing Address - Country:US
Mailing Address - Phone:213-758-8880
Mailing Address - Fax:213-758-8882
Practice Address - Street 1:430 S GARFIELD AVE STE 300
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3876
Practice Address - Country:US
Practice Address - Phone:213-758-8880
Practice Address - Fax:213-758-8882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-26
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based