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General NPI Number Information
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NPI Number | 1982174512
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Entity Type | Organization
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Legal Business Name | OMEGALIFE HOSPICE OF CALIFORNIA, INC.
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Dates
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Enumeration Date | 11/27/2018
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Last Update Date | 12/11/2020
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Provider Practice Location Address
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Address Line | 21151 S WESTERN AVE STE 256
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City | TORRANCE
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State | CA
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Zip | 90501-1724
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Country | US
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Telephone | 310-755-2540
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Fax |
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Provider Business Mailing Address
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Address Line | 21151 S WESTERN AVE STE 256
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City | TORRANCE
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State | CA
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Zip | 90501-1724
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Country | US
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Telephone | 310-755-2540
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SHELLYDALE P GRAY
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Credential |
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Telephone | 310-357-0398
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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 |
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License Number State |
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