MEDICARE: FULL CIRCLE 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	:	1518554971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULL CIRCLE HOSPICE

Provider Business Mailing Address
First Line	:	2828 E 12TH ST UNIT 2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-3622
Country	:	US
Telephone Number	:	619-495-0797
Fax Number	:

Provider Business Practice Location Address
First Line	:	2828 E 12TH ST UNIT 2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-3622
Country	:	US
Telephone Number	:	619-495-0797
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ASHLEY J MULLENBACH
Credential	:
Telephone Number	:	619-495-0797

Provider Enumeration Date	:	12/30/2020
Last Update Date	:	12/30/2020

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Directions to “FULL CIRCLE HOSPICE ” Practice Location

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