Provider Demographics
NPI:1326618646
Name:CROWN VALLEY HOSPICE
Entity Type:Organization
Organization Name:CROWN VALLEY HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REN CHELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-551-1838
Mailing Address - Street 1:21545 VINTAGE WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-5758
Mailing Address - Country:US
Mailing Address - Phone:909-551-1838
Mailing Address - Fax:
Practice Address - Street 1:22600 LAMBERT ST STE 1002
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1622
Practice Address - Country:US
Practice Address - Phone:909-551-1838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based