Provider Demographics
NPI:1861956575
Name:E.C. LILLY PALLIATIVE CARE AND HOSPICE AGENCY, INC.
Entity type:Organization
Organization Name:E.C. LILLY PALLIATIVE CARE AND HOSPICE AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILIA
Authorized Official - Middle Name:ANDALLO
Authorized Official - Last Name:RETUTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-387-8169
Mailing Address - Street 1:1942 DEL PASO RD STE 130-100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-7718
Mailing Address - Country:US
Mailing Address - Phone:916-993-6358
Mailing Address - Fax:916-514-8580
Practice Address - Street 1:1942 DEL PASO RD STE 130-100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-7718
Practice Address - Country:US
Practice Address - Phone:916-993-6358
Practice Address - Fax:916-514-8580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-27
Last Update Date:2019-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based