Healthcare Provider Details

I. General information

NPI: 1003586355
Provider Name (Legal Business Name): IE HOSPICE SERVICES ,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8333 FOOTHILL BLVD STE 111
RANCHO CUCAMONGA CA
91730-3155
US

IV. Provider business mailing address

19326 EMPTY SADDLE RD
WALNUT CA
91789-4285
US

V. Phone/Fax

Practice location:
  • Phone: 909-579-8237
  • Fax: 626-236-4146
Mailing address:
  • Phone: 626-272-2754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. CLIFFORD R VILLAFLOR SR.
Title or Position: CEO
Credential:
Phone: 909-579-8237