Provider Demographics
NPI:1093054611
Name:HARBOR HOSPICE OF LOS ANGELES, LP
Entity Type:Organization
Organization Name:HARBOR HOSPICE OF LOS ANGELES, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF DATA OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:THIBODAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-813-2332
Mailing Address - Street 1:4955 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1801
Mailing Address - Country:US
Mailing Address - Phone:213-358-5090
Mailing Address - Fax:818-528-1255
Practice Address - Street 1:3406 COLLEGE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4612
Practice Address - Country:US
Practice Address - Phone:409-813-2332
Practice Address - Fax:409-232-0573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based