Provider Demographics
NPI:1467867523
Name:AMAVI HOME HEALTH AND HOSPICE CARE SERVICES, INC.
Entity Type:Organization
Organization Name:AMAVI HOME HEALTH AND HOSPICE CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REGGIE
Authorized Official - Middle Name:SANTIAGO
Authorized Official - Last Name:PANGANIBAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-684-7979
Mailing Address - Street 1:131 SAND CREEK RD STE K
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-7348
Mailing Address - Country:US
Mailing Address - Phone:925-684-7979
Mailing Address - Fax:925-684-7287
Practice Address - Street 1:131 SAND CREEK RD STE K
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-7348
Practice Address - Country:US
Practice Address - Phone:925-684-7979
Practice Address - Fax:925-684-7287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-27
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherIRS