1891361242 NPI number — EXTRA MILE 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 1891361242 NPI number — EXTRA MILE HOSPICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXTRA MILE 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:
1891361242
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3401C W ORANGEWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-276-9431
Provider Business Mailing Address Fax Number:
714-276-9431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3401 C W. ORANGEWOOD AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868-9286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-276-9431
Provider Business Practice Location Address Fax Number:
714-276-9431
Provider Enumeration Date:
05/27/2021

Additional Information

Authorized Official

Authorized Official Last Name:
MISA
Authorized Official First Name:
MA. TERESA
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-515-0459

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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