=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871047282
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GSR HOSPICE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2016
-----------------------------------------------------
Last Update Date | 08/15/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 837 N LA CADENA DR STE B
-----------------------------------------------------
City | COLTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92324-2747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-963-0992
-----------------------------------------------------
Fax | 909-963-1335
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 837 N LA CADENA DR STE B
-----------------------------------------------------
City | COLTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92324-2747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-963-0992
-----------------------------------------------------
Fax | 909-963-1335
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ELIZA TOKMADJIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 909-963-0992
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------