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General NPI Number Information
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NPI Number | 1285243386
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL LIFECARE HOSPICE, INC.
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Dates
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Enumeration Date | 07/24/2020
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Last Update Date | 07/24/2020
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Provider Practice Location Address
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Address Line | 8363 RESEDA BLVD UNIT 200B
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City | NORTHRIDGE
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State | CA
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Zip | 91324-4623
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Country | US
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Telephone | 818-818-6509
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Fax | 888-315-8448
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Provider Business Mailing Address
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Address Line | 8363 RESEDA BLVD UNIT 200B
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City | NORTHRIDGE
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State | CA
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Zip | 91324-4623
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Country | US
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Telephone | 818-818-6509
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Fax | 888-315-8448
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Authorized Official
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Title or Position | CEO
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Name | MR. JAMES CONRAD CONTRERAS
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Credential | NURSE PRATITIONER
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Telephone | 818-818-6509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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