Provider Demographics
NPI:1730798836
Name:ALL LIVES MATTER HOSPICE
Entity type:Organization
Organization Name:ALL LIVES MATTER HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LATEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-521-7555
Mailing Address - Street 1:1254 S WATERMAN AVE STE 45
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-2858
Mailing Address - Country:US
Mailing Address - Phone:909-521-7555
Mailing Address - Fax:909-494-5434
Practice Address - Street 1:1254 S WATERMAN AVE STE 45
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2858
Practice Address - Country:US
Practice Address - Phone:909-521-7555
Practice Address - Fax:909-494-5434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based