Provider Demographics
NPI:1780139964
Name:BRENTON HOSPICE INC.
Entity type:Organization
Organization Name:BRENTON HOSPICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-727-3707
Mailing Address - Street 1:8560 VINEYARD AVENUE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4349
Mailing Address - Country:US
Mailing Address - Phone:909-727-3707
Mailing Address - Fax:909-727-3326
Practice Address - Street 1:8560 VINEYARD AVENUE
Practice Address - Street 2:SUITE 410
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4349
Practice Address - Country:US
Practice Address - Phone:909-727-3707
Practice Address - Fax:909-727-3326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X
CA550003871251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based