Provider Demographics
NPI:1003249475
Name:RELIANCE HOSPICE SERVICES, INC.
Entity Type:Organization
Organization Name:RELIANCE HOSPICE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAURITZEN
Authorized Official - Suffix:
Authorized Official - Credentials:NHA 7607
Authorized Official - Phone:818-548-2684
Mailing Address - Street 1:601 S BRAND BLVD STE 312
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-4040
Mailing Address - Country:US
Mailing Address - Phone:818-433-3624
Mailing Address - Fax:818-333-7285
Practice Address - Street 1:601 S BRAND BLVD STE 312
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4040
Practice Address - Country:US
Practice Address - Phone:818-433-3624
Practice Address - Fax:818-333-7285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based