Provider Demographics
NPI:1659902922
Name:PACIFIC COAST HOSPICE INC
Entity Type:Organization
Organization Name:PACIFIC COAST HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HOLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-877-8067
Mailing Address - Street 1:20953 DEVONSHIRE ST STE 8B
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-2371
Mailing Address - Country:US
Mailing Address - Phone:310-877-8067
Mailing Address - Fax:
Practice Address - Street 1:20953 DEVONSHIRE ST STE 8B
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-2371
Practice Address - Country:US
Practice Address - Phone:310-877-8067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based