Provider Demographics
NPI:1477689818
Name:MIRAFAITH HOSPICE INC.
Entity Type:Organization
Organization Name:MIRAFAITH HOSPICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FERNAND
Authorized Official - Middle Name:BAMBA
Authorized Official - Last Name:TARUC
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:818-951-9040
Mailing Address - Street 1:7471 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-2726
Mailing Address - Country:US
Mailing Address - Phone:818-951-9040
Mailing Address - Fax:818-951-9002
Practice Address - Street 1:7471 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-2726
Practice Address - Country:US
Practice Address - Phone:818-951-9040
Practice Address - Fax:818-951-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551549Medicare Oscar/Certification