Bright Haven Hospice Care Corporation

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

BRIGHT HAVEN HOSPICE CARE CORPORATION

Doing business as

Bright Haven Hospice

Practice address

9631 Business Center Drive
Suite C
Rancho Cucamonga, CA 91730-4545

Phone

(909) 644-7649

Fax

(909) 752-4180

NPI assigned

Jun 25, 2008

Last updated

Jun 25, 2008By 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

Mrs. Marites Dividina Gonzales

Title

RN Ceo

Phone

(909) 644-7649

Specialties & licenses 1

Addresses

Other names 1

• Bright Haven 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 1215199922. Details of each certification follow.

• CCN 551775 Hospice · Active · Details

Hospice certification: CCN 551775

Legal name

BRIGHT HAVEN HOSPICE CARE CORPORATION

Doing business as

BRIGHT HAVEN HOSPICE

Certification status

Active

Provider type (POS)

Hospice

Participating since

Oct 12, 2013

Last certification

Jul 25, 2019

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Apr 18, 2007 in CA

Enrollment address

9631 Business Center Dr
C
Rancho Cucamonga, CA 91730-4545

Listed as

Bright Haven HospiceCCN 551775 · All quality measures

Ownership

For-Profit

Certified

Oct 12, 2013

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 2

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.

• Gimha Sudhani Gunawardana, M.D

  • Internal Medicine Physician
  • Pomona, CA
  • NPI 1720274921

  W-2 Managing Employee

  CMS ownership

Affiliated clinicians 2

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

• Jose I Arciniega, D.O.

  • Family Medicine Physician
  • Fontana, CA
  • NPI 1265642052

  Hospice

  Care Compare affiliation
• Gimha Sudhani Gunawardana, M.D

  • Internal Medicine Physician
  • Pomona, CA
  • NPI 1720274921

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1214352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1215199922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9631 BUSINESS CENTER DR",
            "address_2": "SUITE C",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917304545",
            "telephone_number": "909-644-7649",
            "fax_number": "909-752-4180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9631 BUSINESS CENTER DRIVE",
            "address_2": "SUITE C",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917304545",
            "telephone_number": "909-644-7649",
            "fax_number": "909-752-4180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIGHT HAVEN HOSPICE CARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-25",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "GONZALES",
        "authorized_official_first_name": "MARITES",
        "authorized_official_middle_name": "DIVIDINA",
        "authorized_official_title_or_position": "RN CEO",
        "authorized_official_telephone_number": "909-644-7649",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bright Haven 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 Jun 25, 2008; 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.