Healthcare Provider Details

I. General information

NPI: 1225586951
Provider Name (Legal Business Name): PROVIDENCE HOSPICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 W RAMSEY ST STE A
BANNING CA
92220-4817
US

IV. Provider business mailing address

66 W RAMSEY ST SUITE A
BANNING CA
92220-4817
US

V. Phone/Fax

Practice location:
  • Phone: 909-326-6010
  • Fax: 909-326-6011
Mailing address:
  • Phone: 909-326-6010
  • Fax: 909-326-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberC3926029
License Number StateCA

VIII. Authorized Official

Name: BEATRIZ GABRIELLE
Title or Position: ADMINISTRATOR
Credential:
Phone: 909-326-6010