Provider Demographics
NPI:1093792996
Name:MAJESTY HOSPICE, INC.
Entity Type:Organization
Organization Name:MAJESTY HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES / CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARY ALYN
Authorized Official - Middle Name:ABAD
Authorized Official - Last Name:DOMONDON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:323-819-1472
Mailing Address - Street 1:4221 WILSHIRE BLVD
Mailing Address - Street 2:STE 480
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3512
Mailing Address - Country:US
Mailing Address - Phone:323-634-9907
Mailing Address - Fax:323-634-9906
Practice Address - Street 1:4221 WILSHIRE BLVD
Practice Address - Street 2:STE 480
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3512
Practice Address - Country:US
Practice Address - Phone:323-634-9907
Practice Address - Fax:323-634-9906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01753FMedicaid
CA051753Medicare ID - Type Unspecified