MEDICARE: UMBRELLA 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	:	1922665991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UMBRELLA HOSPICE, INC

Provider Business Mailing Address
First Line	:	4221 WILSHIRE BLVD STE 170-14
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3519
Country	:	US
Telephone Number	:	323-272-3648
Fax Number	:	323-272-3680

Provider Business Practice Location Address
First Line	:	4221 WILSHIRE BLVD STE 170-14
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3519
Country	:	US
Telephone Number	:	323-272-3648
Fax Number	:	323-272-3680

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SOJUNG SUK
Credential	:	AGNP-PC
Telephone Number	:	323-272-3648

Provider Enumeration Date	:	05/23/2019
Last Update Date	:	09/29/2022

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