Provider Demographics
NPI:1932454360
Name:LIGHTHOUSE HOSPICE CARE INC
Entity Type:Organization
Organization Name:LIGHTHOUSE HOSPICE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LILIBETH
Authorized Official - Middle Name:SIOSON
Authorized Official - Last Name:SAN GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:909-989-8884
Mailing Address - Street 1:1763 JUNE LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-2315
Mailing Address - Country:US
Mailing Address - Phone:909-989-8884
Mailing Address - Fax:909-989-8834
Practice Address - Street 1:10535 FOOTHILL BLVD STE 408
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3829
Practice Address - Country:US
Practice Address - Phone:909-989-8884
Practice Address - Fax:909-989-8834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1932454360OtherNPI NUMBER