Provider Demographics
NPI:1639345010
Name:AUTUMN HOSPICE, INC.
Entity Type:Organization
Organization Name:AUTUMN HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAGES
Authorized Official - Suffix:
Authorized Official - Credentials:NHAP
Authorized Official - Phone:626-622-2034
Mailing Address - Street 1:12062 VALLEY VIEW ST STE 216
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-1739
Mailing Address - Country:US
Mailing Address - Phone:626-622-2034
Mailing Address - Fax:
Practice Address - Street 1:12062 VALLEY VIEW ST STE 216
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-1739
Practice Address - Country:US
Practice Address - Phone:626-622-2034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based