Provider Demographics
NPI:1144834722
Name:BLUE WAVE HOSPICE INC.
Entity type:Organization
Organization Name:BLUE WAVE HOSPICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MESIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-713-6140
Mailing Address - Street 1:2331 W LINCOLN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-5103
Mailing Address - Country:US
Mailing Address - Phone:714-713-6140
Mailing Address - Fax:
Practice Address - Street 1:2323 W LINCOLN AVE # 207A
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5100
Practice Address - Country:US
Practice Address - Phone:714-713-6140
Practice Address - Fax:714-948-8914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-01
Last Update Date:2023-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based