Provider Demographics
NPI:1427431360
Name:AZURE HEALTH GROUP INC.
Entity type:Organization
Organization Name:AZURE HEALTH GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DOVE
Authorized Official - Middle Name:GABRIELLE
Authorized Official - Last Name:DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-996-6879
Mailing Address - Street 1:222 N MOUNTAIN AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5714
Mailing Address - Country:US
Mailing Address - Phone:909-906-1888
Mailing Address - Fax:
Practice Address - Street 1:222 N MOUNTAIN AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5714
Practice Address - Country:US
Practice Address - Phone:909-906-1888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based