1730163148 NPI number — PACIFIC HOSPICE CARE CORPORATION

Table of content: (NPI 1730163148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730163148 NPI number — PACIFIC HOSPICE CARE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC HOSPICE CARE CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730163148
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17141 VENTURA BLVD STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENCINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91316-4038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-382-3825
Provider Business Mailing Address Fax Number:
213-386-1664

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17141 VENTURA BLVD STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENCINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91316-4038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-382-3825
Provider Business Practice Location Address Fax Number:
213-826-1664
Provider Enumeration Date:
11/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BOYM
Authorized Official First Name:
ALEXANDER
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
213-382-3835

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  980001560 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HPC01768F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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