Provider Demographics
NPI:1710346192
Name:DIRECT PROVIDER OF HOSPICE INC
Entity type:Organization
Organization Name:DIRECT PROVIDER OF HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYLVIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-930-0209
Mailing Address - Street 1:487 CORONA MALL
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-1419
Mailing Address - Country:US
Mailing Address - Phone:951-393-0020
Mailing Address - Fax:951-393-0958
Practice Address - Street 1:487 CORONA MALL
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-1419
Practice Address - Country:US
Practice Address - Phone:951-393-0020
Practice Address - Fax:951-393-0958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based