Provider Demographics
NPI:1053910604
Name:AMICI HOSPICE, INC.
Entity type:Organization
Organization Name:AMICI HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HERMIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-210-1144
Mailing Address - Street 1:7121 MAGNOLIA AVE STE F
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3805
Mailing Address - Country:US
Mailing Address - Phone:951-355-5537
Mailing Address - Fax:
Practice Address - Street 1:7121 MAGNOLIA AVE STE F
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-3805
Practice Address - Country:US
Practice Address - Phone:951-355-5537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based