Provider Demographics
NPI:1093337784
Name:BRIGHT SOURCE HOSPICE LLC
Entity type:Organization
Organization Name:BRIGHT SOURCE HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:QUERUBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:IGNACIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-383-7760
Mailing Address - Street 1:226 S BEVERLY DR STE 217
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3844
Mailing Address - Country:US
Mailing Address - Phone:310-383-7760
Mailing Address - Fax:310-405-0808
Practice Address - Street 1:226 S BEVERLY DR STE 217
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3844
Practice Address - Country:US
Practice Address - Phone:310-383-7760
Practice Address - Fax:310-405-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-15
Last Update Date:2024-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based