Healthcare Provider Details

I. General information

NPI: 1114949203
Provider Name (Legal Business Name): VNA HOSPICE AND PALLIATIVE CARE OF SOUTHERN CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28200 CALIFORNIA 189 #02-240
LAKE ARROWHEAD CA
92352-9700
US

IV. Provider business mailing address

PO BOX 2230
LAKE ARROWHEAD CA
92352-2230
US

V. Phone/Fax

Practice location:
  • Phone: 909-336-7781
  • Fax: 909-337-7770
Mailing address:
  • Phone: 909-336-7781
  • Fax: 909-337-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number240000861
License Number StateCA

VIII. Authorized Official

Name: MARSHA FOX
Title or Position: PRESIDENT/CEO
Credential:
Phone: 909-624-3574