MEDICARE: AVIVA HOSPICE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1043826811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVIVA HOSPICE, INC.

Provider Business Mailing Address
First Line	:	1200 CALIFORNIA ST STE 130
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92374-2946
Country	:	US
Telephone Number	:	909-284-5600
Fax Number	:	909-284-5602

Provider Business Practice Location Address
First Line	:	1200 CALIFORNIA ST STE 130
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92374-2946
Country	:	US
Telephone Number	:	909-284-5600
Fax Number	:	909-284-5602

Authorized Official
Title or Position	:	CEO
Name	:	AGNES PUZON
Credential	:
Telephone Number	:	909-284-5600

Provider Enumeration Date	:	09/17/2020
Last Update Date	:	01/11/2024

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