Provider Demographics
NPI:1578814638
Name:A SPIRIT OF SUPPORT INC
Entity type:Organization
Organization Name:A SPIRIT OF SUPPORT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHERWIN
Authorized Official - Middle Name:TANGHAL
Authorized Official - Last Name:CANALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-305-1007
Mailing Address - Street 1:425 W BONITA AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2542
Mailing Address - Country:US
Mailing Address - Phone:909-305-1007
Mailing Address - Fax:909-305-1001
Practice Address - Street 1:425 W BONITA AVE STE 209
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2542
Practice Address - Country:US
Practice Address - Phone:909-305-1007
Practice Address - Fax:909-305-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-28
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based