MEDICARE: PH CARE OF CALIFORNIA, 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	:	1558629295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PH CARE OF CALIFORNIA, INC.

Provider Business Mailing Address
First Line	:	655 N CENTRAL AVE
Second Line	:	17TH FLOOR
City	:	GLENDALE
State	:	CA
Zip	:	91203-1422
Country	:	US
Telephone Number	:	818-277-4749
Fax Number	:

Provider Business Practice Location Address
First Line	:	4530 E SHEA BLVD
Second Line	:	STE 165
City	:	PHOENIX
State	:	AZ
Zip	:	85028-6065
Country	:	US
Telephone Number	:	602-274-7572
Fax Number	:	602-274-5465

Authorized Official
Title or Position	:	COO
Name	:	MRS. YOLANDA M GREENE
Credential	:
Telephone Number	:	602-274-7572

Provider Enumeration Date	:	05/01/2012
Last Update Date	:	04/15/2013

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