Provider Demographics
NPI:1366157026
Name:ANTHEM HOSPICE PROVIDERS, INC.
Entity type:Organization
Organization Name:ANTHEM HOSPICE PROVIDERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:EFREN
Authorized Official - Middle Name:
Authorized Official - Last Name:RILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-943-8081
Mailing Address - Street 1:850 VIA LATA STE 118
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3985
Mailing Address - Country:US
Mailing Address - Phone:909-533-4553
Mailing Address - Fax:
Practice Address - Street 1:850 VIA LATA STE 118
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3985
Practice Address - Country:US
Practice Address - Phone:909-533-4553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based