Provider Demographics
NPI:1538696588
Name:AVID HOSPICE INC
Entity Type:Organization
Organization Name:AVID HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:GALBRAITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-391-9002
Mailing Address - Street 1:12387 LEWIS ST STE 202
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-4666
Mailing Address - Country:US
Mailing Address - Phone:909-391-9002
Mailing Address - Fax:844-361-4435
Practice Address - Street 1:12387 LEWIS ST STE 202
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4666
Practice Address - Country:US
Practice Address - Phone:909-391-9002
Practice Address - Fax:844-361-4435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-20
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based