Provider Demographics
NPI:1548841695
Name:MARYMONTE HOSPICE
Entity type:Organization
Organization Name:MARYMONTE HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PRITHVI
Authorized Official - Middle Name:
Authorized Official - Last Name:AIYASWAMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-802-5798
Mailing Address - Street 1:2102 BUSINESS CENTER DR STE 292
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1001
Mailing Address - Country:US
Mailing Address - Phone:949-247-7518
Mailing Address - Fax:949-430-7824
Practice Address - Street 1:2102 BUSINESS CENTER DR STE 292
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1001
Practice Address - Country:US
Practice Address - Phone:949-247-7518
Practice Address - Fax:949-430-7824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based