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General NPI Number Information
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NPI Number | 1780012260
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Entity Type | Organization
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Legal Business Name | LAKESIDE HOSPICE CARE, INC.
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Dates
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Enumeration Date | 10/21/2013
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Last Update Date | 02/02/2022
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Provider Practice Location Address
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Address Line | 800 N HARBOR BLVD STE A
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City | LA HABRA
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State | CA
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Zip | 90631-3165
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Country | US
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Telephone | 714-871-0099
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Fax | 714-871-0110
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Provider Business Mailing Address
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Address Line | 800 N HARBOR BLVD STE A
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City | LA HABRA
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State | CA
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Zip | 90631-3165
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Country | US
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Telephone | 714-871-0099
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Fax | 714-871-0110
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GLENN DAOS DAYAP
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Credential | RN, BSN
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Telephone | 714-871-0099
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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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