MEDICARE: COMPASSUS OP 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	:	1922558287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSUS OP OF CALIFORNIA LLC

Provider Business Mailing Address
First Line	:	3110 W LAKE CENTER DR
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-6917
Country	:	US
Telephone Number	:	714-445-0407
Fax Number	:	855-212-0422

Provider Business Practice Location Address
First Line	:	3110 W LAKE CENTER DR
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-6917
Country	:	US
Telephone Number	:	714-445-0407
Fax Number	:	855-212-0422

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANTHONY JAMES
Credential	:
Telephone Number	:	615-224-8028

Provider Enumeration Date	:	10/11/2016
Last Update Date	:	10/11/2016

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