Provider Demographics
NPI:1801221049
Name:MIRACLE MILE HOSPICE CARE, INC.
Entity Type:Organization
Organization Name:MIRACLE MILE HOSPICE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:DE GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:323-951-0880
Mailing Address - Street 1:5670 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1600A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036
Mailing Address - Country:US
Mailing Address - Phone:323-951-0880
Mailing Address - Fax:323-951-0890
Practice Address - Street 1:5670 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1600A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036
Practice Address - Country:US
Practice Address - Phone:323-951-0880
Practice Address - Fax:323-951-0890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550002580OtherCDPH FACILITY LICENSE