MEDICARE: CLEMENT CARE 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	:	1790329266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEMENT CARE HOSPICE, INC.

Provider Business Mailing Address
First Line	:	720 BROOKSIDE AVE STE 103
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92373-5189
Country	:	US
Telephone Number	:	310-818-7786
Fax Number	:	909-363-9167

Provider Business Practice Location Address
First Line	:	720 BROOKSIDE AVE STE 103
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92373-5189
Country	:	US
Telephone Number	:	310-818-7786
Fax Number	:	909-363-9167

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ELMER N HEBIA
Credential	:
Telephone Number	:	909-206-7699

Provider Enumeration Date	:	10/29/2019
Last Update Date	:	10/29/2019

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