Provider Demographics
NPI:1710346192
Name:DIRECT PROVIDER OF HOSPICE INC
Entity Type:Organization
Organization Name:DIRECT PROVIDER OF HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PANGANIBAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:909-727-3013
Mailing Address - Street 1:9320 BASELINE RD STE B-2
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-5829
Mailing Address - Country:US
Mailing Address - Phone:909-727-3013
Mailing Address - Fax:909-992-3047
Practice Address - Street 1:9320 BASELINE RD STE B-2
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-5829
Practice Address - Country:US
Practice Address - Phone:909-727-3013
Practice Address - Fax:909-992-3047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based