Provider Demographics
NPI:1710643986
Name:ST. LUKE'S HOSPICE AGENCY
Entity Type:Organization
Organization Name:ST. LUKE'S HOSPICE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO/SEC/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:V
Authorized Official - Last Name:ROQUE
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:818-426-7730
Mailing Address - Street 1:14545 FRIAR ST STE 322-1
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2397
Mailing Address - Country:US
Mailing Address - Phone:818-426-7730
Mailing Address - Fax:747-264-1436
Practice Address - Street 1:14545 FRIAR ST STE 322-1
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2397
Practice Address - Country:US
Practice Address - Phone:818-426-7730
Practice Address - Fax:747-264-1436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH1000XNursing Service ProvidersRegistered NurseHospiceGroup - Single Specialty