Provider Demographics
NPI:1013064765
Name:HOLY FAMILY HOSPICE CARE INC
Entity Type:Organization
Organization Name:HOLY FAMILY HOSPICE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:PRIMICIAS
Authorized Official - Last Name:PRUDENCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-974-8984
Mailing Address - Street 1:310 E ROWLAND ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3151
Mailing Address - Country:US
Mailing Address - Phone:626-974-8984
Mailing Address - Fax:626-967-9956
Practice Address - Street 1:310 E ROWLAND ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3151
Practice Address - Country:US
Practice Address - Phone:626-974-8984
Practice Address - Fax:626-967-9956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551565Medicare Oscar/Certification