Provider Demographics
NPI:1366507048
Name:MERCY HOSPICE, LLC
Entity Type:Organization
Organization Name:MERCY HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTACT PERSON
Authorized Official - Prefix:MS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:JORNIAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-841-8879
Mailing Address - Street 1:211 W ALAMEDA AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-2570
Mailing Address - Country:US
Mailing Address - Phone:818-841-8879
Mailing Address - Fax:818-841-8680
Practice Address - Street 1:211 W ALAMEDA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2570
Practice Address - Country:US
Practice Address - Phone:818-841-8879
Practice Address - Fax:818-841-8680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-24
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551572Medicare Oscar/Certification