Provider Demographics
NPI:1205383932
Name:CITADEL HOSPICE INC.
Entity Type:Organization
Organization Name:CITADEL HOSPICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:RUAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-328-4967
Mailing Address - Street 1:5050 PALO VERDE ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2329
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5050 PALO VERDE ST
Practice Address - Street 2:SUITE 220
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2329
Practice Address - Country:US
Practice Address - Phone:714-328-4967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-11
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based