Provider Demographics
NPI:1457949547
Name:PEACEFUL HAVEN PALLIATIVE CARE, INCORPORATED.
Entity type:Organization
Organization Name:PEACEFUL HAVEN PALLIATIVE CARE, INCORPORATED.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-828-5658
Mailing Address - Street 1:5957 PRESTWICK WAY
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-5136
Mailing Address - Country:US
Mailing Address - Phone:323-828-5658
Mailing Address - Fax:
Practice Address - Street 1:450 N BRAND BLVD STE 600673
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2347
Practice Address - Country:US
Practice Address - Phone:818-505-4836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based