Provider Demographics
NPI:1497010581
Name:QUEEN OF ANGELS HOSPICE INC
Entity Type:Organization
Organization Name:QUEEN OF ANGELS HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NINA ZOE
Authorized Official - Middle Name:
Authorized Official - Last Name:BONOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-453-3371
Mailing Address - Street 1:9017 RESEDA BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-3922
Mailing Address - Country:US
Mailing Address - Phone:818-453-3371
Mailing Address - Fax:866-591-7598
Practice Address - Street 1:9017 RESEDA BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3922
Practice Address - Country:US
Practice Address - Phone:818-453-3371
Practice Address - Fax:866-591-7598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2012-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC3482880251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based