Provider Demographics
NPI:1902408222
Name:CALSTRO HOSPICE HIGH DESERT INC
Entity Type:Organization
Organization Name:CALSTRO HOSPICE HIGH DESERT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-643-6250
Mailing Address - Street 1:14455 PARK AVE STE A
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-2344
Mailing Address - Country:US
Mailing Address - Phone:760-974-0025
Mailing Address - Fax:760-553-9722
Practice Address - Street 1:14455 PARK AVE STE A
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2344
Practice Address - Country:US
Practice Address - Phone:760-974-0025
Practice Address - Fax:760-553-9722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-11
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based