=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912317546
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARBOR HOSPICE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2014
-----------------------------------------------------
Last Update Date | 05/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19725 SHERMAN WAY
-----------------------------------------------------
City | WINNETKA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91306-3601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-248-7235
-----------------------------------------------------
Fax | 818-582-6223
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19725 SHERMAN WAY
-----------------------------------------------------
City | WINNETKA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91306-3601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-248-7235
-----------------------------------------------------
Fax | 818-582-6223
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | FERRAZ ROBIN MOHAMMED
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 626-248-7235
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------