Provider Demographics
NPI:1104239300
Name:QUEEN OF ANGELS HOSPICE, INC.
Entity type:Organization
Organization Name:QUEEN OF ANGELS HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:LOZANO
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:714-983-7700
Mailing Address - Street 1:601 E YORBA LINDA BLVD
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3006
Mailing Address - Country:US
Mailing Address - Phone:714-983-7700
Mailing Address - Fax:844-270-4161
Practice Address - Street 1:601 E YORBA LINDA BLVD
Practice Address - Street 2:SUITE 2E
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870
Practice Address - Country:US
Practice Address - Phone:714-983-7700
Practice Address - Fax:844-326-0655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based