Aviva Hospice, Inc.

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

AVIVA HOSPICE, INC.

Practice address

1200 California St Ste 130
Redlands, CA 92374-2946

Phone

(909) 284-5600

Fax

(909) 284-5602

NPI assigned

Sep 17, 2020

Last updated

Jan 11, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Agnes Puzon

Title

Ceo

Phone

(909) 284-5600

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043826811. Details of each certification follow.

• CCN B21646 Hospice · Active · Details

Hospice certification: CCN B21646

Legal name

AVIVA HOSPICE INC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Aug 4, 2021

Last certification

Aug 4, 2021

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Sep 10, 2020 in CA

Enrollment address

1200 California St
Ste 130
Redlands, CA 92374-2946

Listed as

Aviva Hospice IncCCN B21646 · All quality measures

Ownership

For-Profit

Certified

Aug 4, 2021

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Peter N. Mattar, MD

  • Family Medicine Physician
  • Fontana, CA
  • NPI 1417005422

  Contracted Managing Employee

  CMS ownership

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Soledad O Lee, MD

  • Internal Medicine Physician
  • Buena Park, CA
  • NPI 1063609097

  Hospice

  Care Compare affiliation
• Arvind Kishore Mathur, MD

  • Internal Medicine Physician
  • Hemet, CA
  • NPI 1962726471

  Hospice

  Care Compare affiliation
• Peter N. Mattar, MD

  • Family Medicine Physician
  • Fontana, CA
  • NPI 1417005422

  Hospice

  Care Compare affiliation
• Shahrukh Mohsin

  • Internal Medicine Physician
  • Colton, CA
  • NPI 1306309273

  Hospice

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1043826811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CALIFORNIA ST STE 130",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923742946",
            "telephone_number": "909-284-5600",
            "fax_number": "909-284-5602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 CALIFORNIA ST STE 130",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923742946",
            "telephone_number": "909-284-5600",
            "fax_number": "909-284-5602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVIVA HOSPICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-17",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A",
        "authorized_official_last_name": "PUZON",
        "authorized_official_first_name": "AGNES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "909-284-5600"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community Based Hospice Care Agency in Redlands, CA
• Providers in Redlands, CA by specialty
• Community Based Hospice Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.