Provider Demographics
NPI:1790011310
Name:IVORY HOSPICE, INC
Entity Type:Organization
Organization Name:IVORY HOSPICE, INC
Other - Org Name:IVORY HOSPICE AND PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MA ALMA
Authorized Official - Middle Name:VELASCO
Authorized Official - Last Name:CALUAG
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:323-724-7802
Mailing Address - Street 1:233 E POMONA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91755-7226
Mailing Address - Country:US
Mailing Address - Phone:323-724-7802
Mailing Address - Fax:323-724-7800
Practice Address - Street 1:233 E POMONA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91755-7226
Practice Address - Country:US
Practice Address - Phone:323-724-7802
Practice Address - Fax:323-724-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1790011310Medicaid
CA551643Medicare PIN