=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730752916
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUST LOVE CARE AND HOSPICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2021
-----------------------------------------------------
Last Update Date | 07/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1421 E COOLEY DR STE 15
-----------------------------------------------------
City | COLTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92324-3979
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-699-0605
-----------------------------------------------------
Fax | 909-699-0612
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1421 E COOLEY DR STE 15
-----------------------------------------------------
City | COLTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92324-3979
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-699-0605
-----------------------------------------------------
Fax | 909-699-0612
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/SECRETARY/ADM/DPCS
-----------------------------------------------------
Name | CHRISTINE NATALIE HENRY
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 909-699-0179
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------