Provider Demographics
NPI:1366723181
Name:LOS FELIZ HOSPICE HEALTH CARE
Entity type:Organization
Organization Name:LOS FELIZ HOSPICE HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MELBA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDEVIESO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-396-0240
Mailing Address - Street 1:790 BEAUMONT AVE STE 122
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-5900
Mailing Address - Country:US
Mailing Address - Phone:951-485-7800
Mailing Address - Fax:800-853-5460
Practice Address - Street 1:790 BEAUMONT AVE STE 122
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-5900
Practice Address - Country:US
Practice Address - Phone:951-485-7800
Practice Address - Fax:800-853-5460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550002424251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA751551Medicare Oscar/Certification