Provider Demographics
NPI:1659964500
Name:BALDWIN PARK HOSPICE INC
Entity Type:Organization
Organization Name:BALDWIN PARK HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ADELIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-373-6307
Mailing Address - Street 1:14650 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-5333
Mailing Address - Country:US
Mailing Address - Phone:626-655-8585
Mailing Address - Fax:626-869-2238
Practice Address - Street 1:14650 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-5333
Practice Address - Country:US
Practice Address - Phone:626-655-8585
Practice Address - Fax:626-869-2238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-11
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA626-655-8585Medicaid