Active NPI
Dignified Hospice Care
- Community Based Hospice Care Agency
- Norco, CA
National Provider Identifier
1689214173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- Legal business name
- DIGNIFIED HOSPICE CARE
- Practice address
- 1700 Hamner Ave Ste 212
Norco, CA 92860-2963 - Phone
- (951) 977-8666
- Fax
- (951) 977-8674
- NPI assigned
- Jan 13, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Eddie Ruiz
- Title
- President, Ceo
- Phone
- (951) 977-8666
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Primary |
Addresses
Primary practice location
1700 Hamner Ave Ste 212
Norco, CA 92860-2963
Mailing address
1700 Hamner Ave Ste 212
Norco, CA 92860-2963
Phone (951) 977-8666
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200320000207 | CA | Part A Provider - Hospice | 2163850454 | Practice locations: Norco, CA |
Hospice certification: CCN A01794
- Legal name
- DIGNIFIED HOSPICE CARE
- Doing business as
- NORTHEAST BILLING GROUP
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Sep 14, 2020
- Last certification
- Sep 14, 2020
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- Corporation
- Incorporated
- Dec 3, 2019 in CA
- Enrollment address
- 1700 Hamner Ave
Ste 212
Norco, CA 92860-2963
Care Compare: Hospice
Medicare Care Compare- Listed as
- Dignified Hospice Care
- Ownership
- For-Profit
- Certified
- Sep 14, 2020
- Medicare certification status
- Active
National Provider Directory
National Provider DirectoryLocations
1700 Hamner Ave
Ste 212
Norco, CA 92860
Phone (951) 977-8666
Ownership & related parties
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.
| Name | Role | Since | Share |
|---|---|---|---|
| Eddie D Ruiz | 5% Or Greater Direct Ownership Interest | Dec 1, 2020 | 50% |
| Corporate Officer | Dec 1, 2020 | 50% | |
| Corporate Director | Dec 1, 2020 | 50% | |
| Mowbray P Hagan | Contracted Managing Employee | Jun 1, 2022 | |
| Louis G Rodriguez | 5% Or Greater Direct Ownership Interest | Dec 1, 2020 | 50% |
| Corporate Officer | Dec 1, 2020 | 50% | |
| W-2 Managing Employee | Aug 25, 2023 | 50% |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- Corona, CA
- NPI 1235145590
Contracted Managing Employee
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1578873600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1635379200000",
"number": "1689214173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1700 HAMNER AVE STE 212",
"city": "NORCO",
"state": "CA",
"postal_code": "928602963",
"telephone_number": "951-977-8666",
"fax_number": "951-977-8674"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1700 HAMNER AVE STE 212",
"city": "NORCO",
"state": "CA",
"postal_code": "928602963",
"telephone_number": "951-977-8666",
"fax_number": "951-977-8674"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DIGNIFIED HOSPICE CARE",
"organizational_subpart": "NO",
"enumeration_date": "2020-01-13",
"last_updated": "2021-10-28",
"certification_date": "2021-10-28",
"status": "A",
"authorized_official_last_name": "RUIZ",
"authorized_official_first_name": "EDDIE",
"authorized_official_title_or_position": "PRESIDENT, CEO",
"authorized_official_telephone_number": "951-977-8666"
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2021; 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.