Provider Demographics
NPI:1467637165
Name:PATIENT CARE HOSPICE, INC.
Entity Type:Organization
Organization Name:PATIENT CARE HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MORENO
Authorized Official - Middle Name:PROBADORA
Authorized Official - Last Name:DE LA ROSA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:909-624-3818
Mailing Address - Street 1:4959 PALO VERDE ST
Mailing Address - Street 2:206C-6
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2331
Mailing Address - Country:US
Mailing Address - Phone:909-624-3818
Mailing Address - Fax:909-398-4359
Practice Address - Street 1:4959 PALO VERDE ST
Practice Address - Street 2:206C-6
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2331
Practice Address - Country:US
Practice Address - Phone:909-624-3818
Practice Address - Fax:909-398-4359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-01
Last Update Date:2008-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based