MEDICARE: ST. ANN HOSPICE, INC.

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		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346225125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. ANN HOSPICE, INC.

Provider Business Mailing Address
First Line	:	1612 W GLENOAKS BLVD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-1814
Country	:	US
Telephone Number	:	818-551-4900
Fax Number	:	818-551-4907

Provider Business Practice Location Address
First Line	:	1612 W GLENOAKS BLVD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-1814
Country	:	US
Telephone Number	:	818-551-4900
Fax Number	:	818-551-4907

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. AMELOU GILL
Credential	:	RN, BSN, CHPN
Telephone Number	:	818-551-4900

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	01/31/2008

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