Provider Demographics
NPI:1821652678
Name:RISING SUN HOSPICE, LLC
Entity Type:Organization
Organization Name:RISING SUN HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONCHITA
Authorized Official - Middle Name:O
Authorized Official - Last Name:DIATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-770-1244
Mailing Address - Street 1:8700 RESEDA BLVD STE 218
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4087
Mailing Address - Country:US
Mailing Address - Phone:818-527-1108
Mailing Address - Fax:818-527-1186
Practice Address - Street 1:8700 RESEDA BLVD STE 218
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4087
Practice Address - Country:US
Practice Address - Phone:818-527-1108
Practice Address - Fax:818-527-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based