Provider Demographics
NPI:1780646109
Name:LOS ANGELES HAVEN HOSPICE INC
Entity Type:Organization
Organization Name:LOS ANGELES HAVEN HOSPICE INC
Other - Org Name:HAVEN HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-426-7500
Mailing Address - Street 1:2855 TEMPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-2212
Mailing Address - Country:US
Mailing Address - Phone:562-426-7500
Mailing Address - Fax:562-684-4689
Practice Address - Street 1:2855 TEMPLE AVE
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-2212
Practice Address - Country:US
Practice Address - Phone:562-426-7500
Practice Address - Fax:562-684-4689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001449251G00000X
CA980001358251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA051760OtherMEDICARE PROVIDER NUMBER
CAHPCO1718FMedicaid
CAHPC01760FOtherMEDI-CAL
CA051760Medicare Oscar/Certification