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General NPI Number Information
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NPI Number | 1497010581
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Entity Type | Organization
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Legal Business Name | QUEEN OF ANGELS HOSPICE INC
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 10/06/2012
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Provider Practice Location Address
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Address Line | 9017 RESEDA BLVD SUITE 210
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City | NORTHRIDGE
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State | CA
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Zip | 91324-3922
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Country | US
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Telephone | 818-453-3371
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Fax | 866-591-7598
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Provider Business Mailing Address
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Address Line | 9017 RESEDA BLVD SUITE 210
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City | NORTHRIDGE
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State | CA
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Zip | 91324-3922
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Country | US
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Telephone | 818-453-3371
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Fax | 866-591-7598
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Authorized Official
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Title or Position | CEO
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Name | MS. NINA ZOE BONOAN
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Credential |
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Telephone | 818-453-3371
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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 | C3482880
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License Number State | CA
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