Provider Demographics
NPI:1730525684
Name:DIRECT PROVIDER OF HOSPICE, INC
Entity type:Organization
Organization Name:DIRECT PROVIDER OF HOSPICE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNYBETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:DIEGO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:909-319-0635
Mailing Address - Street 1:9320 BASELINE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-5829
Mailing Address - Country:US
Mailing Address - Phone:909-319-0635
Mailing Address - Fax:909-944-3878
Practice Address - Street 1:6671 VIANZA PLACE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-5829
Practice Address - Country:US
Practice Address - Phone:909-319-0635
Practice Address - Fax:909-319-0635
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIRECT PROVIDER OF HEALTHCARE SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based