MEDICARE: PEREGRINE HOSPICE, 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		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336122670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEREGRINE HOSPICE, INC.

Provider Business Mailing Address
First Line	:	1403 LOMITA BLVD
Second Line	:	SUITE 301
City	:	HARBOR CITY
State	:	CA
Zip	:	90710-2076
Country	:	US
Telephone Number	:	310-539-9028
Fax Number	:

Provider Business Practice Location Address
First Line	:	1403 LOMITA BLVD
Second Line	:	SUITE 301
City	:	HARBOR CITY
State	:	CA
Zip	:	90710-2076
Country	:	US
Telephone Number	:	310-539-9028
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR/MEDICAL DIRECTOR
Name	:	DR. NORMA MAALA SARAO
Credential	:	M.D.
Telephone Number	:	310-539-9028

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	08/22/2020

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