MEDICARE: REDLANDS HOSPICE CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	550002216	CA

General Provider Information

NPI Number	:	1083959498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDLANDS HOSPICE CARE, INC.

Provider Business Mailing Address
First Line	:	720 BROOKSIDE AVE STE 102
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92373-5189
Country	:	US
Telephone Number	:	909-335-3500
Fax Number	:	909-801-2088

Provider Business Practice Location Address
First Line	:	720 BROOKSIDE AVE STE 102
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92373-5189
Country	:	US
Telephone Number	:	909-335-3500
Fax Number	:	909-801-2088

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CEL ARDEN DOROTHEO ZALSOS
Credential	:
Telephone Number	:	818-482-4256

Provider Enumeration Date	:	12/11/2012
Last Update Date	:	10/29/2019

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