Provider Demographics
NPI:1811177520
Name:AVA HOSPICE CARE , LP
Entity type:Organization
Organization Name:AVA HOSPICE CARE , LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:ELSAYGH
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:909-569-9271
Mailing Address - Street 1:400 N MOUNTAIN AVE
Mailing Address - Street 2:220
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5176
Mailing Address - Country:US
Mailing Address - Phone:909-569-9271
Mailing Address - Fax:909-396-5933
Practice Address - Street 1:400 N MOUNTAIN AVE
Practice Address - Street 2:220
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5176
Practice Address - Country:US
Practice Address - Phone:909-569-9271
Practice Address - Fax:909-396-5933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIN PROCESS251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based