Provider Demographics
NPI:1629554977
Name:ARCHANGEL HOSPICE, LLC.
Entity Type:Organization
Organization Name:ARCHANGEL HOSPICE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER - SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:ITCHON
Authorized Official - Last Name:CAMUA
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:760-820-1742
Mailing Address - Street 1:PO BOX 3238
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-3238
Mailing Address - Country:US
Mailing Address - Phone:760-820-1742
Mailing Address - Fax:760-820-1752
Practice Address - Street 1:57475 TWENTYNINE PALMS HIGHWAY
Practice Address - Street 2:SUITE 103
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284
Practice Address - Country:US
Practice Address - Phone:760-820-1742
Practice Address - Fax:760-820-1752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-18
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based