Provider Demographics
NPI:1336122670
Name:PEREGRINE HOSPICE, INC.
Entity Type:Organization
Organization Name:PEREGRINE HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:MAALA
Authorized Official - Last Name:SARAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-539-9028
Mailing Address - Street 1:1403 LOMITA BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-2076
Mailing Address - Country:US
Mailing Address - Phone:310-539-9028
Mailing Address - Fax:
Practice Address - Street 1:1403 LOMITA BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-2076
Practice Address - Country:US
Practice Address - Phone:310-539-9028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
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
CAHPC01747FMedicaid
CA051747Medicare ID - Type UnspecifiedPROVIDER NUMBER