Provider Demographics
NPI:1851967368
Name:CROWN POINT HEALTHCARE LLC
Entity Type:Organization
Organization Name:CROWN POINT HEALTHCARE LLC
Other - Org Name:ARDENT HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-401-1369
Mailing Address - Street 1:16486 BERNARDO CENTER DR STE 348
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2530
Mailing Address - Country:US
Mailing Address - Phone:858-952-1786
Mailing Address - Fax:
Practice Address - Street 1:16486 BERNARDO CENTER DR STE 348
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2530
Practice Address - Country:US
Practice Address - Phone:858-952-1786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based