Provider Demographics
NPI:1306265863
Name:ADVANCE HOSPICE SERVICES, INC.
Entity type:Organization
Organization Name:ADVANCE HOSPICE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:C
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-466-1000
Mailing Address - Street 1:3602 INLAND EMPIRE BLVD STE A-238
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-4900
Mailing Address - Country:US
Mailing Address - Phone:909-466-1000
Mailing Address - Fax:909-466-1010
Practice Address - Street 1:3602 INLAND EMPIRE BLVD STE A-238
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4900
Practice Address - Country:US
Practice Address - Phone:909-466-1000
Practice Address - Fax:909-466-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC3659689OtherCORPORATION NUMBER