Provider Demographics
NPI:1336748201
Name:AVEEVA HOSPICE - SOUTH
Entity Type:Organization
Organization Name:AVEEVA HOSPICE - SOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:H
Authorized Official - Last Name:ESTANISLAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-405-3013
Mailing Address - Street 1:3741 MERCED DR STE K
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-4956
Mailing Address - Country:US
Mailing Address - Phone:951-405-3013
Mailing Address - Fax:951-405-3013
Practice Address - Street 1:3741 MERCED DR STE K
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-4956
Practice Address - Country:US
Practice Address - Phone:951-405-3013
Practice Address - Fax:951-405-3013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based