MEDICARE: VALLEY PACIFIC 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

General Provider Information

NPI Number	:	1356956817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY PACIFIC HOSPICE, INC.

Provider Business Mailing Address
First Line	:	1919 WILLIAMS ST STE 310
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-7842
Country	:	US
Telephone Number	:	657-216-1131
Fax Number	:	657-208-7042

Provider Business Practice Location Address
First Line	:	1919 WILLIAMS ST STE 310
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-7842
Country	:	US
Telephone Number	:	657-216-1131
Fax Number	:	657-208-7042

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YAQUELIN ROA
Credential	:
Telephone Number	:	818-521-2256

Provider Enumeration Date	:	09/11/2020
Last Update Date	:	12/06/2023

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