Provider Demographics
NPI:1235282773
Name:PACIFIC HOSPICE CARE CORPORATION
Entity Type:Organization
Organization Name:PACIFIC HOSPICE CARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ZAKHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:VAYNEROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-382-3835
Mailing Address - Street 1:2520 W 6TH ST
Mailing Address - Street 2:201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3174
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2520 W 6TH ST
Practice Address - Street 2:201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3174
Practice Address - Country:US
Practice Address - Phone:213-382-3835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
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
CAHPC01768FMedicaid
CA05-1768Medicare ID - Type Unspecified