Provider Demographics
NPI:1205260130
Name:CANYON LAKE HOSPICE, INC.
Entity type:Organization
Organization Name:CANYON LAKE HOSPICE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/DPCS
Authorized Official - Prefix:
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:MELLINA
Authorized Official - Last Name:THONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-606-7986
Mailing Address - Street 1:41661 ENTERPRISE CIR N STE 217
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5629
Mailing Address - Country:US
Mailing Address - Phone:951-296-0082
Mailing Address - Fax:951-296-0083
Practice Address - Street 1:41661 ENTERPRISE CIR N STE 217
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590
Practice Address - Country:US
Practice Address - Phone:951-296-0082
Practice Address - Fax:951-296-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based