Provider Demographics
NPI:1962177071
Name:HAVEN ANGEL HOSPICE
Entity type:Organization
Organization Name:HAVEN ANGEL HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OSAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANASOURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-224-9008
Mailing Address - Street 1:780 N EUCLID ST STE 204I
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4145
Mailing Address - Country:US
Mailing Address - Phone:714-837-0003
Mailing Address - Fax:714-333-4475
Practice Address - Street 1:780 N EUCLID ST STE 204I
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4145
Practice Address - Country:US
Practice Address - Phone:714-837-0003
Practice Address - Fax:714-333-4475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based