1659620987 NPI number — HOSPICE SPECTRUM INLAND EMPIRE

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 1659620987 NPI number — HOSPICE SPECTRUM INLAND EMPIRE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPICE SPECTRUM INLAND EMPIRE
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:
6
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:
1659620987
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7365 CARNELIAN STREET
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
RANCHO CUCAMONGA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91730-1129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-256-4050
Provider Business Mailing Address Fax Number:
909-440-8100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7365 CARNELIAN STREET
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
RANCHO CUCAMONGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91730-1129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-256-4050
Provider Business Practice Location Address Fax Number:
909-440-8100
Provider Enumeration Date:
08/31/2012

Additional Information

Authorized Official

Authorized Official Last Name:
OMBAO
Authorized Official First Name:
JOEL
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
909-800-0883

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X , with the licence number: 550002207 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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