Healthcare Provider Details

I. General information

NPI: 1558037481
Provider Name (Legal Business Name): QUEENSBRIDGE HOSPICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 E WASHINGTON BLVD STE 107G
COMMERCE CA
90040-1820
US

IV. Provider business mailing address

6400 E WASHINGTON BLVD STE 107G
COMMERCE CA
90040-1820
US

V. Phone/Fax

Practice location:
  • Phone: 747-201-7424
  • Fax: 747-201-7423
Mailing address:
  • Phone: 747-201-7424
  • Fax: 747-201-7423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ADWOA SERWA OSEI NYARKO
Title or Position: ADMINISTRATOR
Credential:
Phone: 661-313-9592