MEDICARE: AUTUMN 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	:	1639345010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTUMN HOSPICE, INC.

Provider Business Mailing Address
First Line	:	12062 VALLEY VIEW ST STE 216
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-1739
Country	:	US
Telephone Number	:	626-622-2034
Fax Number	:

Provider Business Practice Location Address
First Line	:	12062 VALLEY VIEW ST STE 216
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-1739
Country	:	US
Telephone Number	:	626-622-2034
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. LUIS A PAGES
Credential	:	NHAP
Telephone Number	:	626-622-2034

Provider Enumeration Date	:	05/05/2008
Last Update Date	:	05/05/2008

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