MEDICARE: PASSAGE ENTERPRISES INCORPORATED

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	980001487	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326045709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASSAGE ENTERPRISES INCORPORATED

Provider Business Mailing Address
First Line	:	222 W FOOTHILL BLVD
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91741-3356
Country	:	US
Telephone Number	:	626-335-9759
Fax Number	:	626-335-5040

Provider Business Practice Location Address
First Line	:	222 W FOOTHILL BLVD
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91741-3356
Country	:	US
Telephone Number	:	626-335-9759
Fax Number	:	626-335-5040

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DAMARIS FIONA SANTOS
Credential	:	L.V.N.
Telephone Number	:	626-335-9759

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	10/22/2012

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Directions to “PASSAGE ENTERPRISES INCORPORATED ” Practice Location

Language	Start Address	Practice Location

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