Provider Demographics
NPI:1063867851
Name:HEART OF GOLD HOSPICE INC
Entity type:Organization
Organization Name:HEART OF GOLD HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERRY
Authorized Official - Middle Name:N
Authorized Official - Last Name:THACKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-277-7713
Mailing Address - Street 1:4110 EDISON AVE
Mailing Address - Street 2:STE 200A
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-8409
Mailing Address - Country:US
Mailing Address - Phone:909-364-0771
Mailing Address - Fax:909-364-0772
Practice Address - Street 1:4110 EDISON AVE
Practice Address - Street 2:STE 200A
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-8409
Practice Address - Country:US
Practice Address - Phone:909-364-0771
Practice Address - Fax:909-364-0772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC3820021OtherCA CORPORATE CERTIFICATE