Provider Demographics
NPI:1083157119
Name:CHARTER HOSPICE, LLC.
Entity Type:Organization
Organization Name:CHARTER HOSPICE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTORNEY
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-669-1686
Mailing Address - Street 1:5775 E LOS ANGELES AVE STE 226
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-5215
Mailing Address - Country:US
Mailing Address - Phone:805-582-0033
Mailing Address - Fax:805-583-9455
Practice Address - Street 1:5924 E LOS ANGELES AVE STE M
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-5526
Practice Address - Country:US
Practice Address - Phone:909-835-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550002499251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based