Healthcare Provider Details

I. General information

NPI: 1265614044
Provider Name (Legal Business Name): ANGEL CITY HOSPICE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17777 CENTER COURT DR N SUITE 250
CERRITOS CA
90703-9320
US

IV. Provider business mailing address

17777 CENTER COURT DR N SUITE 250
CERRITOS CA
90703-9320
US

V. Phone/Fax

Practice location:
  • Phone: 156-286-0100
  • Fax:
Mailing address:
  • Phone: 562-809-1081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JADE BAUTISTA
Title or Position: PRESIDENT / OWNER
Credential:
Phone: 714-264-1620