Provider Demographics
NPI:1780012260
Name:LAKESIDE HOSPICE CARE, INC.
Entity Type:Organization
Organization Name:LAKESIDE HOSPICE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:DAOS
Authorized Official - Last Name:DAYAP
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:714-871-0099
Mailing Address - Street 1:800 N HARBOR BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-3165
Mailing Address - Country:US
Mailing Address - Phone:714-871-0099
Mailing Address - Fax:714-871-0110
Practice Address - Street 1:800 N HARBOR BLVD STE A
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-3165
Practice Address - Country:US
Practice Address - Phone:714-871-0099
Practice Address - Fax:714-871-0110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-21
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based