MEDICARE: LOVING RAINBOW HOSPICE

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	:	1447763925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVING RAINBOW HOSPICE

Provider Business Mailing Address
First Line	:	13709 BURBANK BLVD
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91401-5040
Country	:	US
Telephone Number	:	818-322-6497
Fax Number	:

Provider Business Practice Location Address
First Line	:	13709 BURBANK BLVD
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91401-5040
Country	:	US
Telephone Number	:	818-322-6497
Fax Number	:

Authorized Official
Title or Position	:	ADMINSTRATOR
Name	:	IRINA BRAUN
Credential	:
Telephone Number	:	818-322-6497

Provider Enumeration Date	:	11/07/2017
Last Update Date	:	11/07/2017

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