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General NPI Number Information
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NPI Number | 1396409561
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Entity Type | Organization
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Legal Business Name | PACIFIC CREST HOSPICE OF THE HIGH DESERT LLC
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 12/14/2021
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Provider Practice Location Address
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Address Line | 13300 11TH STREET
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City | VICTORVILLE
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State | CA
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Zip | 92395
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Country | US
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Telephone | 760-808-2646
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Fax |
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Provider Business Mailing Address
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Address Line | 400 EXCHANGE STE 100
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City | IRVINE
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State | CA
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Zip | 92602-1340
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JOSE LYNCH
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Credential |
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Telephone | 714-673-6810
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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 |
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License Number State |
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