Provider Demographics
NPI:1467430199
Name:ST. LIZ HOSPICE, INC.
Entity Type:Organization
Organization Name:ST. LIZ HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:MORENO
Authorized Official - Last Name:YAO
Authorized Official - Suffix:
Authorized Official - Credentials:CERT HOSPICE ADM
Authorized Official - Phone:213-365-6499
Mailing Address - Street 1:1910 W SUNSET BLVD.
Mailing Address - Street 2:SUITE 420
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-3281
Mailing Address - Country:US
Mailing Address - Phone:213-365-6499
Mailing Address - Fax:888-415-5250
Practice Address - Street 1:1910 W SUNSET BLVD.
Practice Address - Street 2:SUITE 420
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-3281
Practice Address - Country:US
Practice Address - Phone:213-365-6499
Practice Address - Fax:888-415-5250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001331251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01744FOtherMEDI-CAL PROVIDER #
CAHPC01744FOtherMEDI-CAL PROVIDER #