Provider Demographics
NPI:1508446998
Name:FOOTHILL HOSPICE SERVICES
Entity Type:Organization
Organization Name:FOOTHILL HOSPICE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OKSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORNEENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-410-2112
Mailing Address - Street 1:7840 FOOTHILL BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-2907
Mailing Address - Country:US
Mailing Address - Phone:323-410-2112
Mailing Address - Fax:
Practice Address - Street 1:7840 FOOTHILL BLVD STE E
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-2907
Practice Address - Country:US
Practice Address - Phone:323-410-2112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-10
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based