Provider Demographics
NPI:1386074128
Name:SANTA ANA HOSPICE INC
Entity type:Organization
Organization Name:SANTA ANA HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRADNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-430-1922
Mailing Address - Street 1:610 PACIFIC COAST HWY STE 211
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6650
Mailing Address - Country:US
Mailing Address - Phone:562-430-1922
Mailing Address - Fax:
Practice Address - Street 1:610 PACIFIC COAST HWY STE 211
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740
Practice Address - Country:US
Practice Address - Phone:562-430-1683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based