Provider Demographics
NPI:1083664353
Name:COMPANION HOSPICE, LLC
Entity Type:Organization
Organization Name:COMPANION HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PLESICH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:714-557-0883
Mailing Address - Street 1:4199 FLAT ROCK DR.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-5861
Mailing Address - Country:US
Mailing Address - Phone:951-371-4274
Mailing Address - Fax:951-371-6995
Practice Address - Street 1:4199 FLAT ROCK DR.
Practice Address - Street 2:SUITE 200
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-5861
Practice Address - Country:US
Practice Address - Phone:951-371-4274
Practice Address - Fax:951-371-6995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01797FMedicaid
CAHPC01797FMedicaid