Organization Active NPI

Holistic Hospice Care, Inc.

Doing business as Angelicare Hospice

  • Community Based Hospice Care Agency
  • Chino, CA
National Provider Identifier
1770094054
Registry record updated Feb 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
HOLISTIC HOSPICE CARE, INC.
Doing business as
Angelicare Hospice
Practice address
12598 Central Ave Ste 212
Chino, CA 91710-3530
Phone
(888) 552-3202
Fax
(888) 552-3793
NPI assigned
Oct 13, 2017
Last updated
Feb 6, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2025

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

Authorized official

Name
Nora IskandarNPI 1720460330
Title
Owner
Phone
(347) 355-4164

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

12598 Central Ave Ste 212
Chino, CA 91710-3530

Mailing address

12598 Central Ave Ste 212
Chino, CA 91710-3530
Phone (888) 552-3202

Other names 1

  • Angelicare Hospice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181129002230 CA Part A Provider - Hospice 4082958251 Practice locations: Chino, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770094054. Details of each certification follow.

Hospice certification: CCN A01696

Legal name
HOLISTIC HOSPICE CARE, INC.
Doing business as
ANGELICARE HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Dec 12, 2019
Last certification
Dec 12, 2019
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Sep 26, 2017 in CA
Enrollment address
12598 Central Ave
Ste 212
Chino, CA 91710-3530

Care Compare: Hospice

Medicare Care Compare
Listed as
Angelicare HospiceCCN A01696 · All quality measures
Ownership
For-Profit
Certified
Dec 12, 2019
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2289319Holistic Hospice Care Inc12598 Central Ave Suite 212, Chino, CA 91710Certificate of waiverSep 7, 2027

National Provider Directory

National Provider Directory

Locations

12598 Central Ave
Ste 212
Chino, CA 91710
Phone (888) 552-3202

341 W 2nd St
Ste 8
San Bernardino, CA 92401
Phone (909) 300-0508

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Nora Iskandar Individual 5% Or Greater Direct Ownership Interest Sep 1, 2021 33.5%
Corporate OfficerCfo, Board Member, Owner Sep 1, 2021 33.5%
W-2 Managing EmployeeCfo, Board Member, Owner Sep 1, 2021 33.5%
Gene J Mabasa Individual 5% Or Greater Direct Ownership Interest Sep 1, 2021 33.5%
Corporate OfficerCoo, Secretary, Board Member, Ow Sep 1, 2021 33.5%
W-2 Managing EmployeeCoo, Secretary, Board Member, Ow Sep 1, 2021 33.5%
Mariam Mangyan Individual W-2 Managing EmployeeAd; Apr 16, 2022 100%
Eric R Presser Individual Contracted Managing EmployeeMD; Oct 16, 2022 100%
Michael Tadros Individual 5% Or Greater Direct Ownership Interest Sep 1, 2021 33%
Corporate OfficerCeo, Board Member, Owner Sep 1, 2021 33%
W-2 Managing EmployeeCeo, Board Member, Owner Sep 1, 2021 33%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

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

NPI Registry JSON

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

{
    "created_epoch": "1507852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738800000000",
    "number": "1770094054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12598 CENTRAL AVE STE 212",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917103530",
            "telephone_number": "888-552-3202",
            "fax_number": "888-552-3793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12598 CENTRAL AVE STE 212",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917103530",
            "telephone_number": "888-552-3202",
            "fax_number": "888-552-3793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLISTIC HOSPICE CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-13",
        "last_updated": "2025-02-06",
        "certification_date": "2025-02-06",
        "status": "A",
        "authorized_official_last_name": "ISKANDAR",
        "authorized_official_first_name": "NORA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "347-355-4164"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Angelicare Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chino, CA

Sources for this page

Verify at the official NPI Registry.