MEDICARE: AMAYA 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

General Provider Information

NPI Number	:	1366051260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMAYA HOSPICE, INC.

Provider Business Mailing Address
First Line	:	8928 RAYFORD DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3454
Country	:	US
Telephone Number	:	818-963-0657
Fax Number	:

Provider Business Practice Location Address
First Line	:	435 ORANGE SHOW LN STE 106
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-2015
Country	:	US
Telephone Number	:	909-677-2285
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DANE SHORT
Credential	:
Telephone Number	:	818-963-0657

Provider Enumeration Date	:	07/27/2020
Last Update Date	:	07/27/2020

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Directions to “AMAYA HOSPICE, INC. ” Practice Location

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