Provider Demographics
NPI:1427626183
Name:PRECIOUS GEM HOSPICE, INC.
Entity type:Organization
Organization Name:PRECIOUS GEM HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-277-3054
Mailing Address - Street 1:2301 W LINCOLN AVE STE 124B
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-5135
Mailing Address - Country:US
Mailing Address - Phone:714-277-3054
Mailing Address - Fax:714-277-3055
Practice Address - Street 1:2301 W LINCOLN AVE STE 124B
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5135
Practice Address - Country:US
Practice Address - Phone:714-277-3054
Practice Address - Fax:714-277-3055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based