Provider Demographics
NPI:1497344543
Name:BROOKSIDE HOSPICE
Entity Type:Organization
Organization Name:BROOKSIDE HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:NIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-784-5788
Mailing Address - Street 1:2461 E ORANGETHORPE AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-5302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2461 E ORANGETHORPE AVE STE 220
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-5302
Practice Address - Country:US
Practice Address - Phone:626-784-5788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based