Provider Demographics
NPI:1346225125
Name:ST. ANN HOSPICE, INC.
Entity Type:Organization
Organization Name:ST. ANN HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMELOU
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, CHPN
Authorized Official - Phone:818-551-4900
Mailing Address - Street 1:1612 W GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-1814
Mailing Address - Country:US
Mailing Address - Phone:818-551-4900
Mailing Address - Fax:818-551-4907
Practice Address - Street 1:1612 W GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-1814
Practice Address - Country:US
Practice Address - Phone:818-551-4900
Practice Address - Fax:818-551-4907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01726GMedicaid
CAHPC01726GMedicaid