=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376055673
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABBA HOSPICE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2017
-----------------------------------------------------
Last Update Date | 06/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20955 PATHFINDER RD STE 332
-----------------------------------------------------
City | DIAMOND BAR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91765-4055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-468-2033
-----------------------------------------------------
Fax | 909-468-2018
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20955 PATHFINDER RD STE 332
-----------------------------------------------------
City | DIAMOND BAR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91765-4055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-468-2033
-----------------------------------------------------
Fax | 909-468-2018
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. LYNN GALBRAITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 909-468-2033
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------