MEDICARE: AMOR HOSPICE, LLC

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

General Provider Information

NPI Number	:	1528535523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMOR HOSPICE, LLC

Provider Business Mailing Address
First Line	:	99 N SAN ANTONIO AVE STE 310
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91786-4575
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	99 N SAN ANTONIO AVE STE 310
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91786-4575
Country	:	US
Telephone Number	:	650-392-5438
Fax Number	:

Authorized Official
Title or Position	:	PRES./CEO
Name	:	MR. JULIUS CAESAR VARILLA BALDUEZA
Credential	:
Telephone Number	:	650-392-5438

Provider Enumeration Date	:	10/28/2018
Last Update Date	:	10/28/2018

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