=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083123483
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PANACEA HOSPICE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2017
-----------------------------------------------------
Last Update Date | 06/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8215 VAN NUYS BLVD STE 304
-----------------------------------------------------
City | PANORAMA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91402-4810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-247-1253
-----------------------------------------------------
Fax | 747-247-1254
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8215 VAN NUYS BLVD STE 304
-----------------------------------------------------
City | PANORAMA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91402-4810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-247-1253
-----------------------------------------------------
Fax | 747-247-1254
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | ADAM DELOS REYES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 747-247-1253
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------