MEDICARE: MEDICONNECT HOSPICE CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1023875101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICONNECT HOSPICE CARE

Provider Business Mailing Address
First Line	:	13709 BURBANK BLVD STE A
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-5040
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13709 BURBANK BLVD STE A
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-5040
Country	:	US
Telephone Number	:	818-926-4104
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CARLOS H CHU
Credential	:
Telephone Number	:	818-926-4104

Provider Enumeration Date	:	03/05/2024
Last Update Date	:	03/05/2024

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