Provider Demographics
NPI:1225624455
Name:PRIMARY CHOICE HOSPICE CARE INC
Entity Type:Organization
Organization Name:PRIMARY CHOICE HOSPICE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYRA
Authorized Official - Middle Name:ABELLA
Authorized Official - Last Name:LAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-796-0131
Mailing Address - Street 1:25069 REDLANDS BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-4097
Mailing Address - Country:US
Mailing Address - Phone:909-796-0131
Mailing Address - Fax:909-796-0133
Practice Address - Street 1:25069 REDLANDS BLVD STE F
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-4097
Practice Address - Country:US
Practice Address - Phone:909-796-0131
Practice Address - Fax:909-796-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based