MEDICARE: OPTIMUM 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	:	1275857443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMUM HOSPICE CARE, INC.

Provider Business Mailing Address
First Line	:	5652 VINELAND AVE STE 203
Second Line	:
City	:	N HOLLYWOOD
State	:	CA
Zip	:	91601-2062
Country	:	US
Telephone Number	:	818-308-7493
Fax Number	:

Provider Business Practice Location Address
First Line	:	5652 VINELAND AVE STE 203
Second Line	:
City	:	N HOLLYWOOD
State	:	CA
Zip	:	91601-2062
Country	:	US
Telephone Number	:	818-308-7493
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	OFELIA F SANTOS
Credential	:
Telephone Number	:	818-308-7493

Provider Enumeration Date	:	03/17/2010
Last Update Date	:	05/04/2015

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