Provider Demographics
NPI:1578831129
Name:ARBOR VITAE HOSPICE CARE, INC.
Entity Type:Organization
Organization Name:ARBOR VITAE HOSPICE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FARO
Authorized Official - Middle Name:T
Authorized Official - Last Name:OWIESY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-907-8111
Mailing Address - Street 1:802 MAGNOLIA AVE
Mailing Address - Street 2:STE. 106
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1780 TOWN AND COUNTRY DR STE 106
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3618
Practice Address - Country:US
Practice Address - Phone:951-735-3485
Practice Address - Fax:951-735-0900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based