Provider Demographics
NPI:1497347967
Name:TAKARA HOSPICE LLC
Entity Type:Organization
Organization Name:TAKARA HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BLISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-781-2023
Mailing Address - Street 1:333 S JUNIPER ST STE 103
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4924
Mailing Address - Country:US
Mailing Address - Phone:951-234-1007
Mailing Address - Fax:
Practice Address - Street 1:333 S JUNIPER ST STE 103
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4924
Practice Address - Country:US
Practice Address - Phone:951-234-1007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-06
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based