St Mary's Hospice Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

ST MARY'S HOSPICE INC

Practice address

809 S Lemon Ave
Diamond Bar, CA 91789-2906

Phone

(626) 858-6100

Fax

(909) 623-9970

NPI assigned

Apr 20, 2012

Organization subpart

No

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

Authorized official

Name

Phillip Alhir

Title

Ceo

Phone

(626) 858-6100

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Hospice certification: CCN 751791

Legal name

ST MARY'S HOSPICE INC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Apr 20, 2016

Last certification

Apr 11, 2019

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Enrollment address

809 S Lemon Ave
Diamond Bar, CA 91789-2906

Listed as

St. Mary's Hospice, IncCCN 751791 · All quality measures

Ownership

For-Profit

Certified

Apr 20, 2016

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 2

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

• Luther Mangoba, M.D.

  • Family Medicine Physician
  • Riverside, CA
  • NPI 1528041894

  5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, W-2 Managing Employee

  CMS ownership
• Melanchton Atiga Mangoba, M.D.

  • Internal Medicine Physician
  • Riverside, CA
  • NPI 1376605717

  5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer

  CMS ownership

Affiliated clinicians 3

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

• Ahmad M. Alturjuman, M.D., F.A.C.C.

  • Interventional Cardiology Physician
  • Riverside, CA
  • NPI 1114980703

  Hospice

  Care Compare affiliation
• Luther Mangoba, M.D.

  • Family Medicine Physician
  • Riverside, CA
  • NPI 1528041894

  Hospice

  Care Compare affiliation
• Melanchton Atiga Mangoba, M.D.

  • Internal Medicine Physician
  • Riverside, CA
  • NPI 1376605717

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1334880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642809600000",
    "number": "1447517073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 S LEMON AVE",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917892906",
            "telephone_number": "626-858-6100",
            "fax_number": "626-858-6201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 S LEMON AVE",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917892906",
            "telephone_number": "626-858-6100",
            "fax_number": "909-623-9970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MARY'S HOSPICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-20",
        "last_updated": "2022-01-22",
        "certification_date": "2022-01-22",
        "status": "A",
        "authorized_official_last_name": "ALHIR",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "626-858-6100"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Elizabeth Souza, DPT, CHT
• Gary M Souza, DPT, OCS
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• St Jude Hospital Yorba Linda (St Joseph Heritage Healthcare)
• St. Luke's Hospice, Inc.
• Douglas Starr, MD
• Victor J Steele
• Steve Li Chan MD Inc
• Nancy Jill Stoops, M.F.T

• Community Based Hospice Care Agency in Diamond Bar, CA
• Providers in Diamond Bar, 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 22, 2022; 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.