1295118768 NPI number — DEBONAIRE HOSPICE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295118768 NPI number — DEBONAIRE HOSPICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEBONAIRE HOSPICE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295118768
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12139 MOUNT VERNON AVE
Provider Second Line Business Mailing Address:
STE 202
Provider Business Mailing Address City Name:
GRAND TERRACE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92313-5562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-654-6566
Provider Business Mailing Address Fax Number:
877-490-9508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12139 MOUNT VERNON AVE
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
GRAND TERRACE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92313-5562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-654-6566
Provider Business Practice Location Address Fax Number:
877-490-9508
Provider Enumeration Date:
07/02/2015

Additional Information

Authorized Official

Authorized Official Last Name:
IBALE
Authorized Official First Name:
GIOVANNI
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
909-654-6566

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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