=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699135251
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTRA CARE HOSPICE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2016
-----------------------------------------------------
Last Update Date | 02/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3251 W 6TH ST SUITE 418
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90020-5023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-385-5301
-----------------------------------------------------
Fax | 213-385-5343
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3251 W 6TH ST SUITE 418
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90020-5023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-385-5301
-----------------------------------------------------
Fax | 213-385-5343
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | MRS. DIONALYN CATEDRILLA UGBEBOR
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 213-385-5301
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | 550001615
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------