Provider Demographics
NPI:1972177467
Name:LUNA PALLIATIVE CARE AND HOSPICE, INC
Entity type:Organization
Organization Name:LUNA PALLIATIVE CARE AND HOSPICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAKSIM
Authorized Official - Middle Name:
Authorized Official - Last Name:LABUTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-259-2858
Mailing Address - Street 1:72670 FRED WARING DR STE C-203
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-5011
Mailing Address - Country:US
Mailing Address - Phone:760-259-2858
Mailing Address - Fax:323-375-3240
Practice Address - Street 1:72670 FRED WARING DR STE C-203
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-5011
Practice Address - Country:US
Practice Address - Phone:760-259-2858
Practice Address - Fax:323-375-3240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based