Ally Hospice Corporation

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

ALLY HOSPICE CORPORATION

Practice address

202 E Airport Dr Ste 240
San Bernardino, CA 92408-3440

Phone

(909) 891-0900

NPI assigned

Jul 27, 2017

Organization subpart

No

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

Authorized official

Name

Marites Gonzales

Title

Ceo

Phone

(909) 891-0900

Specialties & licenses 1

Addresses

Other names 1

• Ally Hospice Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Hospice certification: CCN B21664

Legal name

ALLY HOSPICE CORPORATION

Doing business as

ALLY HOSPICE

Certification status

Active

Provider type (POS)

Hospice

Participating since

Aug 24, 2021

Last certification

Aug 24, 2021

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Oct 6, 2014 in CA

Enrollment address

202 E Airport Dr
Ste 240
San Bernardino, CA 92408-3404

Listed as

Ally HospiceCCN B21664

Ownership

For-Profit

Certified

Aug 24, 2021

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 4

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 1

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

• 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": "1501113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501113600000",
    "number": "1346764776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9621 SPRINGBROOK COURT",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "91730",
            "telephone_number": "909-644-7649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 E AIRPORT DR STE 240",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083440",
            "telephone_number": "909-891-0900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLY HOSPICE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-27",
        "last_updated": "2017-07-27",
        "status": "A",
        "authorized_official_last_name": "GONZALES",
        "authorized_official_first_name": "MARITES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "909-891-0900"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ally Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community Based Hospice Care Agency in San Bernardino, CA
• Providers in San Bernardino, 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 Jul 27, 2017; 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.