Provider Demographics
NPI:1649579913
Name:FOUR SEASONS HOSPICE CARE INC
Entity Type:Organization
Organization Name:FOUR SEASONS HOSPICE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:RACAZA
Authorized Official - Last Name:OCARIZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-939-5684
Mailing Address - Street 1:4201 WILSHIRE BLVD
Mailing Address - Street 2:SUITE # 516
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3601
Mailing Address - Country:US
Mailing Address - Phone:323-939-5684
Mailing Address - Fax:323-939-5728
Practice Address - Street 1:4201 WILSHIRE BLVD
Practice Address - Street 2:SUITE # 516
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3601
Practice Address - Country:US
Practice Address - Phone:323-939-5684
Practice Address - Fax:323-939-5728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551777Medicare Oscar/Certification