=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306261029
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VNACARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2014
-----------------------------------------------------
Last Update Date | 05/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25220 HANCOCK AVE STE 100
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92562-0901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-658-9288
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2151 E CONVENTION CENTER WAY STE 100
-----------------------------------------------------
City | ONTARIO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91764-5449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-624-3574
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/PRESIDENT
-----------------------------------------------------
Name | MRS. MARSHA FOX
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 909-447-4723
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------