MEDICARE: HOSPICE OF ST JOHN INC

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	251E00000X	Home Health Agency
2	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1962791723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE OF ST JOHN INC

Provider Business Mailing Address
First Line	:	530 S GLENOAKS BLVD STE 206
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91502-2753
Country	:	US
Telephone Number	:	818-843-9990
Fax Number	:	818-843-9991

Provider Business Practice Location Address
First Line	:	530 S GLENOAKS BLVD
Second Line	:	SUITE 206
City	:	BURBANK
State	:	CA
Zip	:	91502-2753
Country	:	US
Telephone Number	:	818-843-9990
Fax Number	:	818-843-9991

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MANEESH A. BANSAL
Credential	:
Telephone Number	:	562-924-9618

Provider Enumeration Date	:	04/01/2011
Last Update Date	:	04/10/2018

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