Provider Demographics
NPI:1801223805
Name:MARY, QUEEN OF ANGELS HOSPICE
Entity Type:Organization
Organization Name:MARY, QUEEN OF ANGELS HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHUONG
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-388-3860
Mailing Address - Street 1:10990 WARNER AVE STE E
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3849
Mailing Address - Country:US
Mailing Address - Phone:855-226-9603
Mailing Address - Fax:
Practice Address - Street 1:10990 WARNER AVE
Practice Address - Street 2:UNIT E
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3849
Practice Address - Country:US
Practice Address - Phone:855-226-9603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-04
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based