MEDICARE: WISHES HOSPICE CARE CORPORATION

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	:	1295321065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISHES HOSPICE CARE CORPORATION

Provider Business Mailing Address
First Line	:	1440 N HARBOR BLVD STE 100A
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92835-4114
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 N HARBOR BLVD STE 100A
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92835-4114
Country	:	US
Telephone Number	:	714-829-8903
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MARCK ANTON S TAMAYO
Credential	:
Telephone Number	:	714-829-8903

Provider Enumeration Date	:	12/16/2020
Last Update Date	:	12/16/2020

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