Provider Demographics
NPI:1790329266
Name:CLEMENT CARE HOSPICE, INC.
Entity Type:Organization
Organization Name:CLEMENT CARE HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:N
Authorized Official - Last Name:HEBIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-206-7699
Mailing Address - Street 1:720 BROOKSIDE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5189
Mailing Address - Country:US
Mailing Address - Phone:310-818-7786
Mailing Address - Fax:909-363-9167
Practice Address - Street 1:720 BROOKSIDE AVE STE 103
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5189
Practice Address - Country:US
Practice Address - Phone:310-818-7786
Practice Address - Fax:909-363-9167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based