MEDICARE: CALAZ

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

General Provider Information

NPI Number	:	1831365436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALAZ

Provider Business Mailing Address
First Line	:	10507 GARDEN GROVE BLVD
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1128
Country	:	US
Telephone Number	:	714-260-0226
Fax Number	:	714-260-0228

Provider Business Practice Location Address
First Line	:	10507 GARDEN GROVE BLVD
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1128
Country	:	US
Telephone Number	:	714-260-0226
Fax Number	:	714-260-0228

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MS. BETTY L KLEBANOFF
Credential	:	RN
Telephone Number	:	714-260-0226

Provider Enumeration Date	:	05/02/2008
Last Update Date	:	05/02/2008

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Directions to “CALAZ ” Practice Location

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