Provider Demographics
NPI:1558629295
Name:PH CARE OF CALIFORNIA, INC.
Entity Type:Organization
Organization Name:PH CARE OF CALIFORNIA, INC.
Other - Org Name:PREMIER HOSPICE AND PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-274-7572
Mailing Address - Street 1:655 N CENTRAL AVE
Mailing Address - Street 2:17TH FLOOR
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1422
Mailing Address - Country:US
Mailing Address - Phone:818-277-4749
Mailing Address - Fax:
Practice Address - Street 1:4530 E SHEA BLVD
Practice Address - Street 2:STE 165
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6065
Practice Address - Country:US
Practice Address - Phone:602-274-7572
Practice Address - Fax:602-274-5465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551616Medicare Oscar/Certification