Provider Demographics
NPI:1659669562
Name:LIRA HOSPICE, INC.
Entity Type:Organization
Organization Name:LIRA HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WITTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-965-2263
Mailing Address - Street 1:6222 WILSHIRE BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5130
Mailing Address - Country:US
Mailing Address - Phone:323-965-2263
Mailing Address - Fax:323-965-2267
Practice Address - Street 1:6222 WILSHIRE BLVD STE 230
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5130
Practice Address - Country:US
Practice Address - Phone:323-965-2263
Practice Address - Fax:323-655-8502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1659669562Medicaid