Provider Demographics
NPI:1952060907
Name:ONEIDA HOSPICE LLC
Entity Type:Organization
Organization Name:ONEIDA HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-763-3345
Mailing Address - Street 1:1264 S WATERMAN AVE STE 38
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-2849
Mailing Address - Country:US
Mailing Address - Phone:909-763-3345
Mailing Address - Fax:909-763-3290
Practice Address - Street 1:1264 S WATERMAN AVE STE 38
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2849
Practice Address - Country:US
Practice Address - Phone:909-763-3345
Practice Address - Fax:909-763-3290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based