Healthcare Provider Details

I. General information

NPI: 1669008934
Provider Name (Legal Business Name): ANGENIDA HOSPICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14081 YORBA ST STE 201
TUSTIN CA
92780-2011
US

IV. Provider business mailing address

14081 YORBA ST STE 201
TUSTIN CA
92780-2011
US

V. Phone/Fax

Practice location:
  • Phone: 714-442-3853
  • Fax: 714-442-4853
Mailing address:
  • Phone: 714-442-3853
  • Fax: 714-442-4853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. FERNAN DAVID
Title or Position: PRESIDENT
Credential:
Phone: 714-442-3853