1164967741 NPI number — CHERRY BLOSSOM HEALTHCARE PALLIATIVE & HOSPICE, INC.

Table of content: ELIZABETH A. KAISER RN, PHN (NPI 1811059066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164967741 NPI number — CHERRY BLOSSOM HEALTHCARE PALLIATIVE & HOSPICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHERRY BLOSSOM HEALTHCARE PALLIATIVE & 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:
1164967741
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
688 N ARROWHEAD AVE
Provider Second Line Business Mailing Address:
STE 205
Provider Business Mailing Address City Name:
SAN BERNARDINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92401-1171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-999-5436
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
688 N ARROWHEAD AVE
Provider Second Line Business Practice Location Address:
STE 205
Provider Business Practice Location Address City Name:
SAN BERNARDINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92401-1171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-999-5436
Provider Business Practice Location Address Fax Number:
888-752-8950
Provider Enumeration Date:
01/05/2017

Additional Information

Authorized Official

Authorized Official Last Name:
SY
Authorized Official First Name:
LORENZ
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
323-236-0872

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)

  • Identifier: 608-15-9853 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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