Provider Demographics
NPI:1326288028
Name:SACRED HEART HOSPICE INC
Entity Type:Organization
Organization Name:SACRED HEART HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MURILLO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:951-681-7022
Mailing Address - Street 1:1935 CHICAGO AVE STE C
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2368
Mailing Address - Country:US
Mailing Address - Phone:951-682-7022
Mailing Address - Fax:951-682-7122
Practice Address - Street 1:2025 CHICAGO AVE
Practice Address - Street 2:STE A30
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2314
Practice Address - Country:US
Practice Address - Phone:951-682-7022
Practice Address - Fax:951-682-7122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000479251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1326288028Medicaid
CA1326288028Medicaid