Provider Demographics
NPI:1356004824
Name:PRECIOUS LIFE HOSPICE CARE CORPORATION
Entity Type:Organization
Organization Name:PRECIOUS LIFE HOSPICE CARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JADE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-770-0152
Mailing Address - Street 1:1440 N HARBOR BLVD STE 103E
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4114
Mailing Address - Country:US
Mailing Address - Phone:714-770-0152
Mailing Address - Fax:800-562-1701
Practice Address - Street 1:1440 N HARBOR BLVD STE 103E
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4114
Practice Address - Country:US
Practice Address - Phone:714-770-0152
Practice Address - Fax:800-562-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based