Provider Demographics
NPI:1780279257
Name:LONG LIFE HOSPICE INC
Entity type:Organization
Organization Name:LONG LIFE HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ROWIE
Authorized Official - Middle Name:QUINCENA
Authorized Official - Last Name:JUCAL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:909-681-6180
Mailing Address - Street 1:4959 PALO VERDE ST STE 206A-4
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2342
Mailing Address - Country:US
Mailing Address - Phone:909-681-6180
Mailing Address - Fax:909-614-8628
Practice Address - Street 1:4959 PALO VERDE ST STE 206A-4
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2342
Practice Address - Country:US
Practice Address - Phone:909-681-6180
Practice Address - Fax:909-614-8628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based