Provider Demographics
NPI:1053988287
Name:PREMIER CARE HOSPICE INC
Entity type:Organization
Organization Name:PREMIER CARE HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FERNANDO AMADO
Authorized Official - Middle Name:
Authorized Official - Last Name:CLENISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-221-3781
Mailing Address - Street 1:600 N MOUNTAIN AVE STE C205D
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4315
Mailing Address - Country:US
Mailing Address - Phone:562-221-3781
Mailing Address - Fax:
Practice Address - Street 1:600 N MOUNTAIN AVE STE C205D
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4315
Practice Address - Country:US
Practice Address - Phone:562-221-3781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based