Provider Demographics
NPI:1376160358
Name:LIVING ANGELS HOSPICE CARE
Entity type:Organization
Organization Name:LIVING ANGELS HOSPICE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HERMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-675-7055
Mailing Address - Street 1:820 N MOUNTAIN AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4163
Mailing Address - Country:US
Mailing Address - Phone:909-675-7055
Mailing Address - Fax:877-684-7043
Practice Address - Street 1:820 N MOUNTAIN AVE STE 105
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4163
Practice Address - Country:US
Practice Address - Phone:909-675-7055
Practice Address - Fax:877-684-7043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based