Provider Demographics
NPI:1659733772
Name:PROMINENCE HOSPICE SERVICES, LLC
Entity Type:Organization
Organization Name:PROMINENCE HOSPICE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TUNGOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-780-4741
Mailing Address - Street 1:9613 ARROW RTE
Mailing Address - Street 2:SUITE L BLDG. 3
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4552
Mailing Address - Country:US
Mailing Address - Phone:626-780-4741
Mailing Address - Fax:
Practice Address - Street 1:9613 ARROW RTE
Practice Address - Street 2:SUITE L BLDG. 3
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4552
Practice Address - Country:US
Practice Address - Phone:626-780-4741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based