MEDICARE: AC 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	550000460	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	:	1497909832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AC HOSPICE, INC.

Provider Business Mailing Address
First Line	:	3870 CRENSHAW BLVD STE 209
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-1815
Country	:	US
Telephone Number	:	323-329-9244
Fax Number	:	323-294-5102

Provider Business Practice Location Address
First Line	:	3870 CRENSHAW BLVD STE 209
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-1815
Country	:	US
Telephone Number	:	323-329-9244
Fax Number	:	323-294-5102

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	AMELIA MELSADIA CAMPBELL-AMPONSEM
Credential	:	RN, MS, BSN, PHN
Telephone Number	:	323-329-9244

Provider Enumeration Date	:	11/12/2008
Last Update Date	:	08/31/2010

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Directions to “AC HOSPICE, INC. ” Practice Location

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