=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346882610
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANGEL CARE HOSPICE LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2019
-----------------------------------------------------
Last Update Date | 12/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4100 W ALAMEDA AVE STE 385
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91505-4195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-200-5470
-----------------------------------------------------
Fax | 747-200-1927
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4100 W ALAMEDA AVE STE 385
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91505-4195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-200-5470
-----------------------------------------------------
Fax | 747-200-1927
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JENNIFER VALDES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 747-200-5470
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------