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General NPI Number Information
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NPI Number | 1811177520
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Entity Type | Organization
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Legal Business Name | AVA HOSPICE CARE , LP
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Dates
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Enumeration Date | 11/09/2007
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 400 N MOUNTAIN AVE 220
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City | UPLAND
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State | CA
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Zip | 91786-5176
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Country | US
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Telephone | 909-569-9271
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Fax | 909-396-5933
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Provider Business Mailing Address
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Address Line | 400 N MOUNTAIN AVE 220
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City | UPLAND
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State | CA
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Zip | 91786-5176
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Country | US
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Telephone | 909-569-9271
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Fax | 909-396-5933
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. VICTORIA B. ELSAYGH
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Credential | REGISTERED NURSE
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Telephone | 909-569-9271
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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 | IN PROCESS
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License Number State | CA
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