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General NPI Number Information
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NPI Number | 1629554977
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Entity Type | Organization
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Legal Business Name | ARCHANGEL HOSPICE, LLC.
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Dates
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Enumeration Date | 07/18/2018
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Last Update Date | 06/01/2023
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Provider Practice Location Address
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Address Line | 57475 TWENTYNINE PALMS HIGHWAY SUITE 103
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City | YUCCA VALLEY
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State | CA
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Zip | 92284
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Country | US
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Telephone | 760-820-1742
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Fax | 760-820-1752
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Provider Business Mailing Address
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Address Line | PO BOX 3238
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City | PALM SPRINGS
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State | CA
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Zip | 92263-3238
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Country | US
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Telephone | 760-820-1742
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Fax | 760-820-1752
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Authorized Official
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Title or Position | BOARD MEMBER - SECRETARY
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Name | CLAIRE ITCHON CAMUA
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Credential | NP-C
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Telephone | 760-820-1742
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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 | CA
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