Provider Demographics
NPI:1649580929
Name:AMBERCITY HOSPICE INC.
Entity Type:Organization
Organization Name:AMBERCITY HOSPICE INC.
Other - Org Name:AMBERCITY HOSPICE INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEKKI
Authorized Official - Middle Name:JONAS
Authorized Official - Last Name:MAWIKERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-747-2072
Mailing Address - Street 1:3590 CENTRAL AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2708
Mailing Address - Country:US
Mailing Address - Phone:951-686-8100
Mailing Address - Fax:951-686-5500
Practice Address - Street 1:3590 CENTRAL AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2708
Practice Address - Country:US
Practice Address - Phone:951-686-8100
Practice Address - Fax:951-686-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based