Provider Demographics
NPI:1467770263
Name:VICTORIA ONE HOSPICE, INC.
Entity Type:Organization
Organization Name:VICTORIA ONE HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-599-0055
Mailing Address - Street 1:448 E FOOTHILL BLVD
Mailing Address - Street 2:STE 204
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-1205
Mailing Address - Country:US
Mailing Address - Phone:909-599-0055
Mailing Address - Fax:909-599-0051
Practice Address - Street 1:448 E FOOTHILL BLVD
Practice Address - Street 2:STE 204
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1205
Practice Address - Country:US
Practice Address - Phone:909-599-0055
Practice Address - Fax:909-599-0051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based