Provider Demographics
NPI:1134556012
Name:IMPERIAL HOSPICE, INC.
Entity type:Organization
Organization Name:IMPERIAL HOSPICE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HOSPICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MA CARMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-292-5364
Mailing Address - Street 1:363 S PARK AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-1560
Mailing Address - Country:US
Mailing Address - Phone:909-992-1914
Mailing Address - Fax:909-992-1913
Practice Address - Street 1:363 S PARK AVE STE 105
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766
Practice Address - Country:US
Practice Address - Phone:909-992-1914
Practice Address - Fax:909-992-1913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2019-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based