=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497909832
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AC HOSPICE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2008
-----------------------------------------------------
Last Update Date | 08/31/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3870 CRENSHAW BLVD STE 209
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90008-1815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-329-9244
-----------------------------------------------------
Fax | 323-294-5102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3870 CRENSHAW BLVD STE 209
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90008-1815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-329-9244
-----------------------------------------------------
Fax | 323-294-5102
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | AMELIA MELSADIA CAMPBELL-AMPONSEM
-----------------------------------------------------
Credential | RN, MS, BSN, PHN
-----------------------------------------------------
Telephone | 323-329-9244
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | 550000460
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------