Avon Hospice Care, Inc.

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

550002342 Issued in CA

Legal business name

AVON HOSPICE CARE, INC.

Doing business as

Manor Hospice

Practice address

9007 Arrow Rte Ste 180
Rancho Cucamonga, CA 91730-4459

Phone

(909) 833-7579

Fax

(909) 833-7580

NPI assigned

Jan 10, 2013

Last updated

Oct 21, 2020By 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

Ms. Lulu Aquino

Title

Ceo

Phone

(909) 481-7579

Specialties & licenses 1

Addresses

Other names 1

• Manor Hospice Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124365184. Details of each certification follow.

• CCN 551766 Hospice · Active · Details

Hospice certification: CCN 551766

Legal name

AVON HOSPICE CARE, INC.

Doing business as

MANOR HOSPICE

Certification status

Active

Provider type (POS)

Hospice

Participating since

Jan 21, 2014

Last certification

Feb 21, 2020

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Nov 21, 2012 in CA

Enrollment address

9007 Arrow Rte
Ste 180
Rancho Cucamonga, CA 91730-4459

Listed as

Manor HospiceCCN 551766 · All quality measures

Ownership

For-Profit

Certified

Jan 21, 2014

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 1

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

Affiliated clinicians 5

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

• Amir Bahreman, M.D.

  • Internal Medicine Physician
  • San Diego, CA
  • NPI 1124249388

  Hospice

  Care Compare affiliation
• Blaine Kenton Jackson, M.D.

  • Internal Medicine Physician
  • Solana Beach, CA
  • NPI 1518079565

  Hospice

  Care Compare affiliation
• Afshin A Nahavandi, M.D.

  • Hospitalist Physician
  • Escondido, CA
  • NPI 1518935808

  Hospice

  Care Compare affiliation
• Richard Thien Nguyen, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • San Diego, CA
  • NPI 1275724361

  Hospice

  Care Compare affiliation
• Michael Anthony Randazzo, MD

  • Internal Medicine Physician
  • Hemet, CA
  • NPI 1457980427

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1357776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603238400000",
    "number": "1124365184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9007 ARROW RTE STE 180",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917304459",
            "telephone_number": "909-481-7579",
            "fax_number": "909-833-7576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9007 ARROW RTE STE 180",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917304459",
            "telephone_number": "909-833-7579",
            "fax_number": "909-833-7580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVON HOSPICE CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-10",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A",
        "authorized_official_last_name": "AQUINO",
        "authorized_official_first_name": "LULU",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "909-481-7579",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "CA",
            "license": "550002342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Manor Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Manor Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community Based Hospice Care Agency in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, 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 Oct 21, 2020; 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.