MEDICARE: OPTUM PALLIATIVE AND HOSPICE CARE, 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
2	251G00000X	Community Based Hospice Care Agency	550001694	CA

General Provider Information

NPI Number	:	1518079383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTUM PALLIATIVE AND HOSPICE CARE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 15645
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89114-5645
Country	:	US
Telephone Number	:	215-902-8241
Fax Number	:	215-902-8809

Provider Business Practice Location Address
First Line	:	3120 W LAKE CENTER DR
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-6917
Country	:	US
Telephone Number	:	714-513-6630
Fax Number	:	855-212-0422

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	JOHN O. ENDERLE
Credential	:
Telephone Number	:	860-221-0793

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	11/04/2015

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