Provider Demographics
NPI:1730760216
Name:WHITE SAND HOSPICE LLC
Entity type:Organization
Organization Name:WHITE SAND HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DAHREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:760-277-3201
Mailing Address - Street 1:15402 W SAGE ST STE 203
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-2355
Mailing Address - Country:US
Mailing Address - Phone:442-255-4133
Mailing Address - Fax:442-327-9114
Practice Address - Street 1:15402 W SAGE ST STE 203
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2355
Practice Address - Country:US
Practice Address - Phone:442-255-4133
Practice Address - Fax:442-327-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based