Provider Demographics
NPI:1205400637
Name:LIGHTHOUSE RIDGE HOSPICE, INC.
Entity Type:Organization
Organization Name:LIGHTHOUSE RIDGE HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-877-9124
Mailing Address - Street 1:10999 RIVERSIDE DR STE 102A
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2239
Mailing Address - Country:US
Mailing Address - Phone:747-877-9124
Mailing Address - Fax:747-877-9125
Practice Address - Street 1:10999 RIVERSIDE DR STE 102A
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-2239
Practice Address - Country:US
Practice Address - Phone:747-877-9124
Practice Address - Fax:747-877-9125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based