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General NPI Number Information
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NPI Number | 1669008934
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Entity Type | Organization
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Legal Business Name | ANGENIDA HOSPICE LLC
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Dates
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Enumeration Date | 03/19/2020
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Last Update Date | 03/19/2020
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Provider Practice Location Address
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Address Line | 14081 YORBA ST STE 201
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City | TUSTIN
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State | CA
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Zip | 92780-2011
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Country | US
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Telephone | 714-442-3853
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Fax | 714-442-4853
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Provider Business Mailing Address
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Address Line | 14081 YORBA ST STE 201
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City | TUSTIN
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State | CA
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Zip | 92780-2011
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Country | US
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Telephone | 714-442-3853
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Fax | 714-442-4853
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. FERNAN DAVID
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Credential |
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Telephone | 714-442-3853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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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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