MEDICARE: HEAVENLY DOVES HOSPICE, 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

General Provider Information

NPI Number	:	1841893427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAVENLY DOVES HOSPICE, INC.

Provider Business Mailing Address
First Line	:	10251 VISTA SORRENTO PKWY STE 280F
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3774
Country	:	US
Telephone Number	:	858-947-4242
Fax Number	:	858-947-4248

Provider Business Practice Location Address
First Line	:	10251 VISTA SORRENTO PKWY STE 280F
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3774
Country	:	US
Telephone Number	:	858-947-4242
Fax Number	:	858-947-4248

Authorized Official
Title or Position	:	CEO
Name	:	IVY EILEEN MEDINA SAMOY
Credential	:
Telephone Number	:	858-947-4242

Provider Enumeration Date	:	11/17/2020
Last Update Date	:	04/20/2026

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