Provider Demographics
NPI:1801399399
Name:ST. JOSEPH HEALTHCARE AGENCY, INC.
Entity Type:Organization
Organization Name:ST. JOSEPH HEALTHCARE AGENCY, INC.
Other - Org Name:ST. JOSEPH HOSPICE & PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARTINS
Authorized Official - Middle Name:
Authorized Official - Last Name:AIYETIWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-989-7700
Mailing Address - Street 1:6550 VAN BUREN BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-1544
Mailing Address - Country:US
Mailing Address - Phone:909-989-5383
Mailing Address - Fax:
Practice Address - Street 1:6550 VAN BUREN BLVD STE F
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-1544
Practice Address - Country:US
Practice Address - Phone:909-989-5383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based