Provider Demographics
NPI:1609450543
Name:HOSPICE OF GREEN PASTURE INC.
Entity Type:Organization
Organization Name:HOSPICE OF GREEN PASTURE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:562-689-8727
Mailing Address - Street 1:860 E LA HABRA BLVD STE 250A
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-0815
Mailing Address - Country:US
Mailing Address - Phone:562-689-8727
Mailing Address - Fax:714-459-8989
Practice Address - Street 1:860 E LA HABRA BLVD STE 250A
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-0815
Practice Address - Country:US
Practice Address - Phone:562-689-8727
Practice Address - Fax:714-459-8989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based