Provider Demographics
NPI:1477100592
Name:MLIFE OF THE DESERT HOSPICE, INC.
Entity Type:Organization
Organization Name:MLIFE OF THE DESERT HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMEDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-996-2508
Mailing Address - Street 1:10590 MAGNOLIA AVE STE F
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-1813
Mailing Address - Country:US
Mailing Address - Phone:760-895-8038
Mailing Address - Fax:760-994-1234
Practice Address - Street 1:74333 HIGHWAY 111 STE 210
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4132
Practice Address - Country:US
Practice Address - Phone:760-895-8038
Practice Address - Fax:760-994-1234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based