Provider Demographics
NPI:1215199922
Name:BRIGHT HAVEN HOSPICE CARE CORPORATION
Entity type:Organization
Organization Name:BRIGHT HAVEN HOSPICE CARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RN CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARITES
Authorized Official - Middle Name:DIVIDINA
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-644-7649
Mailing Address - Street 1:9631 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4545
Mailing Address - Country:US
Mailing Address - Phone:909-644-7649
Mailing Address - Fax:909-752-4180
Practice Address - Street 1:9631 BUSINESS CENTER DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4545
Practice Address - Country:US
Practice Address - Phone:909-644-7649
Practice Address - Fax:909-752-4180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based