MEDICARE: COMPLETE FAITH PALLIATIVE 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	#217032	CA
2	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1225272834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE FAITH PALLIATIVE HOSPICE CARE, INC

Provider Business Mailing Address
First Line	:	14111 FREEWAY DRIVE
Second Line	:	SUITE 318
City	:	SANTA FE SPRINGS
State	:	CA
Zip	:	90670-3658
Country	:	US
Telephone Number	:	562-319-9374
Fax Number	:	951-736-8996

Provider Business Practice Location Address
First Line	:	14111 FREEWAY DRIVE
Second Line	:	SUITE 318
City	:	SANTA FE SPRINGS
State	:	CA
Zip	:	90670-3658
Country	:	US
Telephone Number	:	562-319-9374
Fax Number	:	951-736-8996

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	HILDA C. BLANKENHORN
Credential	:	R.N.
Telephone Number	:	562-319-9374

Provider Enumeration Date	:	04/27/2009
Last Update Date	:	12/02/2009

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