MEDICARE: ONE CARE HOSPICE OF CALIFORNIA, LLC

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	:	1437606787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONE CARE HOSPICE OF CALIFORNIA, LLC

Provider Business Mailing Address
First Line	:	3350 SHELBY ST
Second Line	:	SUITE 370A
City	:	ONTARIO
State	:	CA
Zip	:	91764-4882
Country	:	US
Telephone Number	:	909-784-3500
Fax Number	:	909-620-0789

Provider Business Practice Location Address
First Line	:	3350 SHELBY ST
Second Line	:	SUITE 370A
City	:	ONTARIO
State	:	CA
Zip	:	91764-4882
Country	:	US
Telephone Number	:	909-784-3500
Fax Number	:	909-620-0789

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	JASON PAUL BLISS
Credential	:
Telephone Number	:	909-784-3500

Provider Enumeration Date	:	09/03/2016
Last Update Date	:	11/01/2016

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