MEDICARE: SANTA YEKATERINA 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
2	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	:	1811200553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA YEKATERINA HOSPICE, INC.

Provider Business Mailing Address
First Line	:	5958 VINELAND AVE.
Second Line	:	SUITE J
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-1329
Country	:	US
Telephone Number	:	818-623-8888
Fax Number	:	818-623-0808

Provider Business Practice Location Address
First Line	:	5958 VINELAND AVE.
Second Line	:	SUITE J
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91601-1329
Country	:	US
Telephone Number	:	818-623-8888
Fax Number	:	818-623-0808

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	MR. DANTES VALENZUELA
Credential	:
Telephone Number	:	818-623-8888

Provider Enumeration Date	:	07/22/2010
Last Update Date	:	12/22/2015

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