Healthcare Provider Details

I. General information

NPI: 1841893427
Provider Name (Legal Business Name): HEAVENLY DOVES HOSPICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28481 RANCHO CALIFORNIA RD
TEMECULA CA
92590-3610
US

IV. Provider business mailing address

28481 RANCHO CALIFORNIA RD
TEMECULA CA
92590-3610
US

V. Phone/Fax

Practice location:
  • Phone: 858-947-4242
  • Fax: 858-947-4248
Mailing address:
  • Phone: 858-947-4242
  • Fax: 858-947-4248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: IVY EILEEN MEDINA SAMOY
Title or Position: CEO
Credential:
Phone: 858-947-4242