Provider Demographics
NPI:1538285937
Name:HEARTLAND HOSPICE-WEST COVINA
Entity Type:Organization
Organization Name:HEARTLAND HOSPICE-WEST COVINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DOVIRN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-427-1902
Mailing Address - Street 1:333 N SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1531
Mailing Address - Country:US
Mailing Address - Phone:800-427-1902
Mailing Address - Fax:419-254-5336
Practice Address - Street 1:1000 LAKES DR
Practice Address - Street 2:SUITE 225
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2900
Practice Address - Country:US
Practice Address - Phone:626-918-1207
Practice Address - Fax:626-918-4918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01742FMedicaid