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General NPI Number Information
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NPI Number | 1225586951
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HOSPICE INC
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Dates
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Enumeration Date | 09/12/2016
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Last Update Date | 06/28/2024
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Provider Practice Location Address
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Address Line | 831 N HIGHLAND SPRINGS AVE STE 303D
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City | BEAUMONT
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State | CA
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Zip | 92223-5769
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Country | US
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Telephone | 909-326-6010
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Fax | 909-326-6011
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Provider Business Mailing Address
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Address Line | 831 N HIGHLAND SPRINGS AVE STE 303D
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City | BEAUMONT
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State | CA
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Zip | 92223-5769
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Country | US
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Telephone | 909-326-6010
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Fax | 909-326-6011
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. BEATRIZ GABRIELLE
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Credential |
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Telephone | 909-739-3605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | C3926029
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License Number State | CA
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