Provider Demographics
NPI:1598166068
Name:PACIFIC HOSPICE LLC
Entity Type:Organization
Organization Name:PACIFIC HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RENATO
Authorized Official - Middle Name:D
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-789-0988
Mailing Address - Street 1:11829 SOUTH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6828
Mailing Address - Country:US
Mailing Address - Phone:562-789-0988
Mailing Address - Fax:562-789-8988
Practice Address - Street 1:11829 SOUTH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-6828
Practice Address - Country:US
Practice Address - Phone:562-789-0988
Practice Address - Fax:562-789-8988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based