=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275913758
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRSTCARE HOSPICE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2015
-----------------------------------------------------
Last Update Date | 03/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5500 BOLSA AVE STE 222
-----------------------------------------------------
City | HUNTINGTON BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92649-5705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-732-6290
-----------------------------------------------------
Fax | 714-988-7868
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5500 BOLSA AVE STE 222
-----------------------------------------------------
City | HUNTINGTON BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92649-5705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-732-6290
-----------------------------------------------------
Fax | 714-988-7868
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. DAT NGUYEN
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 657-372-9820
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------