MEDICARE: SEBASTIAN 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	550000458	CA

General Provider Information

NPI Number	:	1548596679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEBASTIAN HOSPICE CARE INC

Provider Business Mailing Address
First Line	:	1720 E LOS ANGELES AVE
Second Line	:	SUITE 218
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-2033
Country	:	US
Telephone Number	:	805-522-5352
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 E LOS ANGELES AVE
Second Line	:	SUITE 218
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-2033
Country	:	US
Telephone Number	:	805-522-5352
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF PATIENT CARE SERVICE
Name	:	MISS MINDA F BOWMAN
Credential	:	RN
Telephone Number	:	805-522-5352

Provider Enumeration Date	:	10/24/2009
Last Update Date	:	11/27/2020

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