MEDICARE: 5 STAR 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	550001417	CA

General Provider Information

NPI Number	:	1255668547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	5 STAR HOSPICE CARE, INC.

Provider Business Mailing Address
First Line	:	13375 UNIVERSITY AVENUE
Second Line	:	SUITE 200
City	:	CLIVE
State	:	IA
Zip	:	50325-8260
Country	:	US
Telephone Number	:	515-221-9155
Fax Number	:	515-221-9157

Provider Business Practice Location Address
First Line	:	675 S. ARROYO PARKWAY
Second Line	:	SUITE 300
City	:	PASADENA
State	:	CA
Zip	:	91105-3264
Country	:	US
Telephone Number	:	626-229-9855
Fax Number	:	626-229-9856

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MS. KATHLEEN M HOGAN
Credential	:
Telephone Number	:	515-221-9155

Provider Enumeration Date	:	11/09/2009
Last Update Date	:	04/23/2012

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