Provider Demographics
NPI:1245661776
Name:RJDJ HOSPICE CARE, INC.
Entity type:Organization
Organization Name:RJDJ HOSPICE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:REYLY JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUSTODIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-914-8444
Mailing Address - Street 1:631 E ARROW HWY STE E
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6036
Mailing Address - Country:US
Mailing Address - Phone:626-914-8444
Mailing Address - Fax:
Practice Address - Street 1:631 E. ARROW HWY STE E
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740
Practice Address - Country:US
Practice Address - Phone:626-914-8444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based