MEDICARE: ECLIPSE 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	:	1265088637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ECLIPSE HOSPICE CARE INC

Provider Business Mailing Address
First Line	:	127 S BRAND BLVD STE 305
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-1388
Country	:	US
Telephone Number	:	818-858-0431
Fax Number	:	818-528-5669

Provider Business Practice Location Address
First Line	:	127 S BRAND BLVD SUITE 305
Second Line	:	127 S BRAND BLVD SUITE 305
City	:	GLENDALE
State	:	CA
Zip	:	91204-1388
Country	:	US
Telephone Number	:	818-858-0431
Fax Number	:	818-528-5669

Authorized Official
Title or Position	:	CEO/ADMINISTRATOR
Name	:	MARIA DIGNA G PONO
Credential	:	RN
Telephone Number	:	818-858-0431

Provider Enumeration Date	:	08/12/2019
Last Update Date	:	07/29/2024

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