Provider Demographics
NPI:1497384226
Name:GLEN-IVY HOSPICE, INC.
Entity Type:Organization
Organization Name:GLEN-IVY HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:WENCYLITO
Authorized Official - Middle Name:LAVAREZ
Authorized Official - Last Name:ALIVIA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:626-936-7650
Mailing Address - Street 1:12440 FIRESTONE BLVD STE 3025-K
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4328
Mailing Address - Country:US
Mailing Address - Phone:213-263-9736
Mailing Address - Fax:
Practice Address - Street 1:12440 FIRESTONE BLVD STE 3025-K
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4328
Practice Address - Country:US
Practice Address - Phone:213-263-9399
Practice Address - Fax:323-287-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-03
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based