Provider Demographics
NPI:1679970305
Name:CORE HOSPICE INC
Entity type:Organization
Organization Name:CORE HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:VILLANUEVA
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:818-800-4065
Mailing Address - Street 1:6505 ROSEMEAD BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-3565
Mailing Address - Country:US
Mailing Address - Phone:562-368-1341
Mailing Address - Fax:562-268-1800
Practice Address - Street 1:6505 ROSEMEAD BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-3565
Practice Address - Country:US
Practice Address - Phone:562-368-1341
Practice Address - Fax:562-268-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based