NPIMap

Organization Active NPI

Lakeside Hospice Care, Inc.

  • Community Based Hospice Care Agency
  • La Habra, CA
National Provider Identifier
1780012260
Registry record updated Feb 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
LAKESIDE HOSPICE CARE, INC.
Practice address
800 N Harbor Blvd Ste a
La Habra, CA 90631-3165
Phone
(714) 871-0099
Fax
(714) 871-0110
NPI assigned
Oct 21, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2022

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

Authorized official

Name
Mr. Glenn Daos Dayap, RN, BSN
Title
President
Phone
(714) 871-0099

Specialties & licenses 1

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

Addresses

Primary practice location

800 N Harbor Blvd Ste a
La Habra, CA 90631-3165

Mailing address

800 N Harbor Blvd Ste a
La Habra, CA 90631-3165
Phone (714) 871-0099

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150930000378 CA Part A Provider - Hospice 9436467149 Practice locations: La Habra, CA

Hospice certification: CCN 921658

Legal name
LAKESIDE HOSPICE CARE INC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 27, 2017
Last certification
Jun 27, 2017
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Dec 4, 2012 in CA
Enrollment address
800 N Harbor Blvd
Ste a
La Habra, CA 90631-3165

Care Compare: Hospice

Medicare Care Compare
Listed as
Lakeside Hospice Care, IncCCN 921658
Ownership
For-Profit
Certified
Jun 27, 2017
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
05D2101194Lakeside Hospice Care Inc800 N Harbor Blvd, Ste a, La Habra, CA 90631Certificate of waiverAug 27, 2027

National Provider Directory

National Provider Directory

Locations

901 W Wilshire Ave
Fullerton, CA 92832
Phone (714) 871-0099

800 N Harbor Blvd
Ste A
La Habra, CA 90631
Phone (714) 871-0099

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.

NameRoleSinceShare
Caroline M Lorenzo Individual 5% Or Greater Direct Ownership Interest Dec 4, 2012 50%
Corporate OfficerSecretary Dec 4, 2012 50%
Corporate DirectorBoard Member Dec 4, 2012 50%
W-2 Managing EmployeeDirector of Patient Care Service Dec 4, 2012 50%
Operational/Managerial ControlBoard Member, Director of Patien Dec 4, 2012 50%
Glenn D Dayap Individual 5% Or Greater Direct Ownership Interest Dec 4, 2012 50%
Corporate OfficerCeo Dec 4, 2012 50%
Corporate DirectorCeo Dec 4, 2012 50%
W-2 Managing EmployeeCeo, Administrator Dec 4, 2012 50%
Operational/Managerial ControlCeo, Administrator Dec 4, 2012 50%
Erwin Q Masinsin Individual W-2 Managing EmployeeGeneral Manager Dec 4, 2012 5%

Practitioners & affiliated clinicians

Affiliated clinicians 2

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": "1382313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643760000000",
    "number": "1780012260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 N HARBOR BLVD STE A",
            "city": "LA HABRA",
            "state": "CA",
            "postal_code": "906313165",
            "telephone_number": "714-871-0099",
            "fax_number": "714-871-0110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 N HARBOR BLVD STE A",
            "city": "LA HABRA",
            "state": "CA",
            "postal_code": "906313165",
            "telephone_number": "714-871-0099",
            "fax_number": "714-871-0110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE HOSPICE CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-21",
        "last_updated": "2022-02-02",
        "certification_date": "2022-02-02",
        "status": "A",
        "authorized_official_last_name": "DAYAP",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "DAOS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-871-0099",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN, BSN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Habra, CA

Sources for this page

Verify at the official NPI Registry.