=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255730115
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LA CARE HOSPICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2014
-----------------------------------------------------
Last Update Date | 08/16/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 596 N LAKE AVE 2ND FLOOR
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101-1455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-818-6456
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 596 N LAKE AVE 2ND FLOOR
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101-1455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-818-6456
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GINA CASTROMAYOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 626-818-6456
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------