1780646109 NPI number — LOS ANGELES HAVEN HOSPICE INC

Table of content: (NPI 1780646109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780646109 NPI number — LOS ANGELES HAVEN HOSPICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOS ANGELES HAVEN HOSPICE INC
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:
HAVEN HOSPICE
Provider Other Organization Name Type Code:
3
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:
1780646109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2855 TEMPLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIGNAL HILL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90755-2212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-426-7500
Provider Business Mailing Address Fax Number:
562-684-4689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2855 TEMPLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIGNAL HILL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90755-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-426-7500
Provider Business Practice Location Address Fax Number:
562-684-4689
Provider Enumeration Date:
04/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KEITZ
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
562-426-7500

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  980001449 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251G00000X , with the licence number: 980001358 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 051760 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HPCO1718F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HPC01760F . This is a "MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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