Provider Demographics
NPI:1053668459
Name:GEMINI HOSPICE, INC.
Entity Type:Organization
Organization Name:GEMINI HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GRELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-387-9649
Mailing Address - Street 1:3450 WILSHIRE BLVD
Mailing Address - Street 2:STE 1125
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2208
Mailing Address - Country:US
Mailing Address - Phone:213-387-9649
Mailing Address - Fax:213-908-1817
Practice Address - Street 1:3450 WILSHIRE BLVD
Practice Address - Street 2:STE 1125
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2208
Practice Address - Country:US
Practice Address - Phone:213-387-9649
Practice Address - Fax:213-908-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based