MEDICARE: RAY OF HOPE HEALTH CARE AGENCY LLC

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	251E00000X	Home Health Agency	201308210660	CA

General Provider Information

NPI Number	:	1346683380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAY OF HOPE HEALTH CARE AGENCY LLC

Provider Business Mailing Address
First Line	:	5701 S WESTERN AVE
Second Line	:	STE 10A
City	:	LOS ANGELES
State	:	CA
Zip	:	90062-2714
Country	:	US
Telephone Number	:	626-367-6987
Fax Number	:

Provider Business Practice Location Address
First Line	:	5701 S WESTERN AVE
Second Line	:	STE 10A
City	:	LOS ANGELES
State	:	CA
Zip	:	90062-2714
Country	:	US
Telephone Number	:	626-367-6987
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CFO
Name	:	BONITA D HACKWORTH
Credential	:
Telephone Number	:	626-367-6987

Provider Enumeration Date	:	04/09/2013
Last Update Date	:	04/09/2013

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