Provider Demographics
NPI:1417377425
Name:COMPREHENSIVE HOSPICE SERVICES LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE HOSPICE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LACE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-945-5619
Mailing Address - Street 1:8619 RESEDA BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4048
Mailing Address - Country:US
Mailing Address - Phone:818-945-5619
Mailing Address - Fax:818-945-5609
Practice Address - Street 1:8619 RESEDA BLVD STE 104
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4048
Practice Address - Country:US
Practice Address - Phone:818-945-5619
Practice Address - Fax:818-243-3861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251100000251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPENDINGMedicare Oscar/Certification