Provider Demographics
NPI:1821570060
Name:DIGNITY HOSPICE
Entity Type:Organization
Organization Name:DIGNITY HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MILES
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLESTEROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-999-7919
Mailing Address - Street 1:9650 BUSINESS CENTER DR STE 107
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4536
Mailing Address - Country:US
Mailing Address - Phone:909-999-7919
Mailing Address - Fax:909-697-2448
Practice Address - Street 1:9650 BUSINESS CENTER DRIVE
Practice Address - Street 2:SUITE 107
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:909-999-7919
Practice Address - Fax:909-697-2448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based