Provider Demographics
NPI:1770539256
Name:NEW HAVEN HOSPICE CARE, INC
Entity type:Organization
Organization Name:NEW HAVEN HOSPICE CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PROCOPIO
Authorized Official - Middle Name:T
Authorized Official - Last Name:MISA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-774-2498
Mailing Address - Street 1:1700 E. LINCOLN AVE #202
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-4323
Mailing Address - Country:US
Mailing Address - Phone:714-774-2498
Mailing Address - Fax:714-774-2485
Practice Address - Street 1:1700 E. LINCOLN AVE #202
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-4323
Practice Address - Country:US
Practice Address - Phone:714-774-2498
Practice Address - Fax:714-774-2485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000792251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC2557938OtherCA SECRETARY OF STATE
CAHPC01788FMedicaid