MEDICARE: DELTA HOSPICE OF CALIFORNIA, 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
2	251G00000X	Community Based Hospice Care Agency	550000365	CA

General Provider Information

NPI Number	:	1194946319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELTA HOSPICE OF CALIFORNIA, INC.

Provider Business Mailing Address
First Line	:	15342 EL PRADO RD
Second Line	:	SUITE 200
City	:	CHINO
State	:	CA
Zip	:	91710-7659
Country	:	US
Telephone Number	:	888-591-0709
Fax Number	:	866-440-8206

Provider Business Practice Location Address
First Line	:	15342 EL PRADO RD
Second Line	:	SUITE 200
City	:	CHINO
State	:	CA
Zip	:	91710-7659
Country	:	US
Telephone Number	:	888-591-0709
Fax Number	:	866-440-8206

Authorized Official
Title or Position	:	CEO/COO, ADMIN
Name	:	MS. VIVIAN OBIAGELI OBIAMALU
Credential	:	LLB
Telephone Number	:	888-591-0709

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	01/13/2015

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