Provider Demographics
NPI:1336696376
Name:AEGIS HOSPICE CARE
Entity Type:Organization
Organization Name:AEGIS HOSPICE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ARIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETRONA
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:909-492-4257
Mailing Address - Street 1:4959 PALO VERDE ST STE 206C-4
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2341
Mailing Address - Country:US
Mailing Address - Phone:909-492-4257
Mailing Address - Fax:909-687-2661
Practice Address - Street 1:4959 PALO VERDE ST STE 206C-4
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2341
Practice Address - Country:US
Practice Address - Phone:909-492-4257
Practice Address - Fax:909-687-2661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based