Ivy Hospice Care, Inc.
Organization Active NPI Community Based Hospice Care Agency · Upland, CA
NPI 1972909596 · NPPES record last updated Aug 31, 2026
Key facts
- NPI
- 1972909596
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- IVY HOSPICE CARE, INC.
- Practice address
- 545 N Mountain Ave Ste 101
Upland, CA 91786-5054 - Phone
- (909) 931-5090
- Fax
- (909) 931-5908
- NPI assigned
- Nov 10, 2014
- Organization subpart
- No
Authorized official
- Name
- Joel Mangilit
- Title
- President/Ceo & Administrator
- Phone
- (909) 931-5090
Owners & managing parties with NPI records 1
-
Dejun Wang, M.D.
Medicare Care Compare: Hospice
- Listed as
- Ivy Hospice Care, Inc
- Ownership
- For-Profit
- Certified
- Jul 29, 2015
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2089436 | Ivy Hospice Care, Inc | Certificate of waiver | Dec 29, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Hospice certification: CCN 751688
- Legal name
- IVY HOSPICE CARE INC
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Jul 29, 2015
- Last certification
- Sep 13, 2018
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- Corporation · Proprietary
- Incorporated
- Oct 14, 2014 in CA
- Enrollment address
- 545 N Mountain Ave
Ste 101
Upland, CA 91786-5054
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Melanie Lourdes S Ros |
5% Or Greater Direct Ownership Interest |
Nov 1, 2024 | 44.83% |
| Joel M. Mangilit |
Corporate Officer |
Jan 1, 2026 | 100% |
| Corporate Director |
Jan 1, 2026 | 100% | |
| W-2 Managing Employee |
Jan 1, 2026 | 50% | |
| Christian Rubio |
W-2 Managing Employee |
Jan 1, 2026 | 50% |
| Dejun Wang |
Contracted Managing Employee |
Nov 6, 2014 | 100% |
| Margarita S Arcilla |
5% Or Greater Direct Ownership Interest |
Nov 1, 2024 | 55.17% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20141126001185 | CA | Part a Provider - Hospice | 0547582637 | Practice locations: Upland, CA |
National Provider Directory
Locations
545 N Mountain Ave
Ste 101
Upland, CA 91786
Phone (909) 931-5090
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
545 N Mountain Ave Ste 101
Upland, CA 91786-5054
Mailing address
545 N Mountain Ave Ste 101
Upland, CA 91786-5054
Phone (909) 931-5090
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All providers in Upland, CA · Community Based Hospice Care Agency in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 31, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.