Provider Demographics
NPI:1326045709
Name:PASSAGE ENTERPRISES INCORPORATED
Entity Type:Organization
Organization Name:PASSAGE ENTERPRISES INCORPORATED
Other - Org Name:COMMUNITY CARE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAMARIS
Authorized Official - Middle Name:FIONA
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:626-335-9759
Mailing Address - Street 1:222 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-3356
Mailing Address - Country:US
Mailing Address - Phone:626-335-9759
Mailing Address - Fax:626-335-5040
Practice Address - Street 1:222 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-3356
Practice Address - Country:US
Practice Address - Phone:626-335-9759
Practice Address - Fax:626-335-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001487251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01762FMedicaid
CAHPC01762FMedicaid