Provider Demographics
NPI:1669607651
Name:IMMANUEL HOSPICE, INC.
Entity type:Organization
Organization Name:IMMANUEL HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:FOLKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-592-4834
Mailing Address - Street 1:482 W. ARROW HWY
Mailing Address - Street 2:SUITE G
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2960
Mailing Address - Country:US
Mailing Address - Phone:909-592-4834
Mailing Address - Fax:909-592-1708
Practice Address - Street 1:482 W. ARROW HWY
Practice Address - Street 2:SUITE G
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2960
Practice Address - Country:US
Practice Address - Phone:909-592-4834
Practice Address - Fax:909-592-1708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based