Provider Demographics
NPI:1760695654
Name:CAREYES HOSPICE INC.
Entity Type:Organization
Organization Name:CAREYES HOSPICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDWINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CAILIPAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-396-6130
Mailing Address - Street 1:1111 GRAND AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4171
Mailing Address - Country:US
Mailing Address - Phone:909-396-6130
Mailing Address - Fax:909-396-1817
Practice Address - Street 1:1111 GRAND AVE
Practice Address - Street 2:SUITE J
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4171
Practice Address - Country:US
Practice Address - Phone:909-396-6130
Practice Address - Fax:909-396-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA551581251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551581Medicaid
CA551581Medicaid