MEDICARE: MID WILSHIRE 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	:	1972185858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID WILSHIRE HOSPICE

Provider Business Mailing Address
First Line	:	1434 HAUSER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-3934
Country	:	US
Telephone Number	:	213-434-1874
Fax Number	:

Provider Business Practice Location Address
First Line	:	1434 HAUSER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-3934
Country	:	US
Telephone Number	:	213-434-1874
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MISS EVET BERRY
Credential	:
Telephone Number	:	213-434-1874

Provider Enumeration Date	:	04/21/2021
Last Update Date	:	04/21/2021

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