Provider Demographics
NPI:1326227604
Name:ST. LUKE'S HOSPICE, INC.
Entity Type:Organization
Organization Name:ST. LUKE'S HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HERMOGINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-444-1100
Mailing Address - Street 1:3333 S BREA CANYON RD
Mailing Address - Street 2:SUITE 221
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3786
Mailing Address - Country:US
Mailing Address - Phone:909-444-1100
Mailing Address - Fax:
Practice Address - Street 1:3333 S BREA CANYON RD
Practice Address - Street 2:SUITE 221
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3786
Practice Address - Country:US
Practice Address - Phone:909-444-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based