Healthcare Provider Details

I. General information

NPI: 1801345731
Provider Name (Legal Business Name): EGB HOLDINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 LATHAM STREET SUITE E
RIVERSIDE CA
92501-1733
US

IV. Provider business mailing address

PO BOX 261485
SAN DIEGO CA
92196-1485
US

V. Phone/Fax

Practice location:
  • Phone: 951-393-1333
  • Fax: 951-393-1555
Mailing address:
  • Phone: 951-393-1333
  • Fax: 951-393-1555

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: EMIL BUNDANG
Title or Position: CEO
Credential:
Phone: 951-393-1333