Provider Demographics
NPI:1477129179
Name:LIFE CARES HOSPICE
Entity Type:Organization
Organization Name:LIFE CARES HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ISAIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-332-7713
Mailing Address - Street 1:1264 S WATERMAN AVE STE 28
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-2848
Mailing Address - Country:US
Mailing Address - Phone:909-332-7713
Mailing Address - Fax:909-494-7532
Practice Address - Street 1:1264 S WATERMAN AVE STE 28
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2848
Practice Address - Country:US
Practice Address - Phone:909-332-7713
Practice Address - Fax:909-494-7532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based