MEDICARE: THE VILLAGE MANOR HOSPICE

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		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	:	1689650558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE VILLAGE MANOR HOSPICE

Provider Business Mailing Address
First Line	:	3860 CRENSHAW BLVD
Second Line	:	STE 219A
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-1816
Country	:	US
Telephone Number	:	323-299-9499
Fax Number	:

Provider Business Practice Location Address
First Line	:	3860 CRENSHAW BLVD
Second Line	:	STE 219A
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-1816
Country	:	US
Telephone Number	:	323-299-9499
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. EVELYN ANN BOOKER
Credential	:	LISW
Telephone Number	:	323-299-9499

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	08/22/2020

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Directions to “THE VILLAGE MANOR HOSPICE ” Practice Location

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