Provider Demographics
NPI:1275204133
Name:SACRED HAVEN HOSPICE INC
Entity Type:Organization
Organization Name:SACRED HAVEN HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CFO
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN MERICK ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DICHOSO
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:909-297-1489
Mailing Address - Street 1:400 N MOUNTAIN AVE STE 231
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5191
Mailing Address - Country:US
Mailing Address - Phone:909-297-1489
Mailing Address - Fax:
Practice Address - Street 1:400 N MOUNTAIN AVE STE 231
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5191
Practice Address - Country:US
Practice Address - Phone:909-297-1489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based