Provider Demographics
NPI:1538462148
Name:NOVA HOME HOSPICE INC
Entity type:Organization
Organization Name:NOVA HOME HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOSTAFA
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAHIMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-686-3121
Mailing Address - Street 1:1551 W 13TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-2900
Mailing Address - Country:US
Mailing Address - Phone:909-946-1213
Mailing Address - Fax:
Practice Address - Street 1:1551 W 13TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-2900
Practice Address - Country:US
Practice Address - Phone:909-946-1213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89780251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based