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General NPI Number Information
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NPI Number | 1780250092
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Entity Type | Organization
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Legal Business Name | LEGACY ADVANTAGE CARE HOSPICE, INC
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Dates
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Enumeration Date | 05/28/2021
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Last Update Date | 05/28/2021
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Provider Practice Location Address
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Address Line | 1733 N PALM CANYON DR STE C
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City | PALM SPRINGS
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State | CA
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Zip | 92262-2957
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Country | US
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Telephone | 760-760-4446
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Fax | 760-760-4448
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Provider Business Mailing Address
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Address Line | 1733 N PALM CANYON DR STE C
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City | PALM SPRINGS
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State | CA
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Zip | 92262-2957
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Country | US
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Telephone | 760-760-4446
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Fax | 760-760-4448
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Authorized Official
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Title or Position | CEO
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Name | ANNA SOGOMONIAN
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Credential |
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Telephone | 760-760-4446
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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 |
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