Provider Demographics
NPI:1497909832
Name:AC HOSPICE, INC.
Entity Type:Organization
Organization Name:AC HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:MELSADIA
Authorized Official - Last Name:CAMPBELL-AMPONSEM
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS, BSN, PHN
Authorized Official - Phone:323-329-9244
Mailing Address - Street 1:3870 CRENSHAW BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-1815
Mailing Address - Country:US
Mailing Address - Phone:323-329-9244
Mailing Address - Fax:323-294-5102
Practice Address - Street 1:3870 CRENSHAW BLVD STE 209
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-1815
Practice Address - Country:US
Practice Address - Phone:323-329-9244
Practice Address - Fax:323-294-5102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000460251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC51579FMedicaid
CAHPC51579FMedicaid