Provider Demographics
NPI:1437258860
Name:PEREGRINE HOSPICE, INC.
Entity Type:Organization
Organization Name:PEREGRINE HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SARAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-371-3080
Mailing Address - Street 1:3440 W CARSON ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5730
Mailing Address - Country:US
Mailing Address - Phone:310-371-3080
Mailing Address - Fax:310-371-3359
Practice Address - Street 1:3440 W CARSON ST
Practice Address - Street 2:SUITE 301
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5730
Practice Address - Country:US
Practice Address - Phone:310-371-3080
Practice Address - Fax:310-371-3359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
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
CAHPC01747FOtherMEDI-CAL ID
CA051747Medicare ID - Type UnspecifiedMEDICARE PROVIDER #