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General NPI Number Information
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NPI Number | 1689716797
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Entity Type | Organization
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Legal Business Name | CHARTER HOSPICE OF COLTON, LLC
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 11/06/2018
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Provider Practice Location Address
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Address Line | 1007 E COOLEY DR STE 100
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City | COLTON
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State | CA
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Zip | 92324-3901
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Country | US
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Telephone | 909-825-2969
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Fax |
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Provider Business Mailing Address
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Address Line | 1012 EAST COOLEY DRIVE SUITE G
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City | COLTON
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State | CA
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Zip | 92324-3959
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Country | US
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Telephone | 909-825-2969
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Fax | 909-825-8751
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Authorized Official
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Title or Position | ATTORNEY
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Name | SYLVIE BOAL
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Credential | ESQ
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Telephone | 866-669-1686
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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 | 550000224
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License Number State | CA
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