MEDICARE: COMFORT CARE HOSPICE PROVIDERS

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	:	1932501814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMFORT CARE HOSPICE PROVIDERS

Provider Business Mailing Address
First Line	:	2139 TAPO ST STE 208
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-3476
Country	:	US
Telephone Number	:	805-888-5900
Fax Number	:	805-624-8181

Provider Business Practice Location Address
First Line	:	2139 TAPO ST STE 208
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-3476
Country	:	US
Telephone Number	:	805-791-3055
Fax Number	:	805-791-3059

Authorized Official
Title or Position	:	CEO
Name	:	MR. KEON MARDANPOUR
Credential	:
Telephone Number	:	805-888-5900

Provider Enumeration Date	:	09/22/2014
Last Update Date	:	03/12/2024

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