Provider Demographics
NPI:1043236169
Name:EMANATE HEALTH HOSPICE
Entity Type:Organization
Organization Name:EMANATE HEALTH HOSPICE
Other - Org Name:EMANATE HEALTH HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT DIRECTOR, BUSINESS SERVIC
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA O
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-732-3105
Mailing Address - Street 1:PO BOX 840146
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-0146
Mailing Address - Country:US
Mailing Address - Phone:626-814-0333
Mailing Address - Fax:626-732-3196
Practice Address - Street 1:820 N PHILLIPS AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791
Practice Address - Country:US
Practice Address - Phone:626-859-2266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA07736FMedicaid
CAZZZ22890ZOtherBLUE SHIELD PROV#
CA057736Medicare Oscar/Certification