Provider Demographics
NPI:1659620987
Name:HOSPICE SPECTRUM INLAND EMPIRE
Entity Type:Organization
Organization Name:HOSPICE SPECTRUM INLAND EMPIRE
Other - Org Name:ASSURANCE HOSPICE INLAND EMPIRE INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:OMBAO
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:909-800-0883
Mailing Address - Street 1:7365 CARNELIAN STREET
Mailing Address - Street 2:SUITE 220
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1129
Mailing Address - Country:US
Mailing Address - Phone:909-256-4050
Mailing Address - Fax:909-440-8100
Practice Address - Street 1:7365 CARNELIAN STREET
Practice Address - Street 2:SUITE 220
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1129
Practice Address - Country:US
Practice Address - Phone:909-256-4050
Practice Address - Fax:909-440-8100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X
CA550002207251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based