Provider Demographics
NPI:1639790561
Name:ADVANCE HOSPICE AND PALLIATIVE CARE, INC.
Entity Type:Organization
Organization Name:ADVANCE HOSPICE AND PALLIATIVE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISHIA KEANNAHJ
Authorized Official - Middle Name:
Authorized Official - Last Name:HIDALGO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:626-233-4003
Mailing Address - Street 1:14545 FRIAR ST STE 266
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2397
Mailing Address - Country:US
Mailing Address - Phone:626-233-4003
Mailing Address - Fax:888-752-8950
Practice Address - Street 1:14545 FRIAR ST STE 266
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2397
Practice Address - Country:US
Practice Address - Phone:626-233-4003
Practice Address - Fax:888-752-8950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-01
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based