MEDICARE: COMPANION HOSPICE AND PALLIATIVE CARE SERVICES, LLC

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

General Provider Information

NPI Number	:	1710224712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPANION HOSPICE AND PALLIATIVE CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	6133 BRISTOL PKWY
Second Line	:	#180
City	:	CULVER CITY
State	:	CA
Zip	:	90230-6609
Country	:	US
Telephone Number	:	855-810-1970
Fax Number	:	714-557-4439

Provider Business Practice Location Address
First Line	:	6133 BRISTOL PKWY
Second Line	:	#180
City	:	CULVER CITY
State	:	CA
Zip	:	90230-6609
Country	:	US
Telephone Number	:	855-810-1970
Fax Number	:	714-557-4439

Authorized Official
Title or Position	:	REGIONAL DIRECTOR OF REIMBURSEMENT
Name	:	MS. VERONICA BAYNE
Credential	:
Telephone Number	:	714-664-0974

Provider Enumeration Date	:	01/10/2013
Last Update Date	:	08/17/2015

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