Provider Demographics
NPI:1396156832
Name:SUMMER BREEZE HOSPICE AND PALLIATIVE CARE, INC.
Entity type:Organization
Organization Name:SUMMER BREEZE HOSPICE AND PALLIATIVE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:WELLINGTON
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLOS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:213-494-8761
Mailing Address - Street 1:609 W BEVERLY BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3623
Mailing Address - Country:US
Mailing Address - Phone:323-483-5078
Mailing Address - Fax:323-978-1632
Practice Address - Street 1:609 W BEVERLY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3623
Practice Address - Country:US
Practice Address - Phone:323-483-5078
Practice Address - Fax:323-978-1632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1396156832OtherNPI