Provider Demographics
NPI:1346703915
Name:ST. AUGUSTINE HOSPICE, INC.
Entity Type:Organization
Organization Name:ST. AUGUSTINE HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABARICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-532-5108
Mailing Address - Street 1:8333 FOOTHILL BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3155
Mailing Address - Country:US
Mailing Address - Phone:909-739-3605
Mailing Address - Fax:
Practice Address - Street 1:8333 FOOTHILL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3155
Practice Address - Country:US
Practice Address - Phone:909-739-3605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based