MEDICARE: JJ HOSPICE CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1114508751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JJ HOSPICE CARE, INC.

Provider Business Mailing Address
First Line	:	810 GREENBRIAR AVE
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-5624
Country	:	US
Telephone Number	:	747-666-1276
Fax Number	:	800-681-1672

Provider Business Practice Location Address
First Line	:	6320 CANOGA AVE STE 1571
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-2526
Country	:	US
Telephone Number	:	747-666-1276
Fax Number	:	800-681-1672

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	AMELIA BANAS
Credential	:
Telephone Number	:	747-666-1276

Provider Enumeration Date	:	04/15/2021
Last Update Date	:	04/15/2021

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