Provider Demographics
NPI:1558579326
Name:OLIVE DYNASTY HOSPICE CARE, INC.
Entity Type:Organization
Organization Name:OLIVE DYNASTY HOSPICE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARILOU
Authorized Official - Middle Name:
Authorized Official - Last Name:LUGTU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:310-410-9998
Mailing Address - Street 1:8929 S SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3616
Mailing Address - Country:US
Mailing Address - Phone:310-410-8833
Mailing Address - Fax:310-410-8844
Practice Address - Street 1:8929 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3616
Practice Address - Country:US
Practice Address - Phone:310-410-8833
Practice Address - Fax:310-410-8844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based