Provider Demographics
NPI:1891372165
Name:MANNA HOSPICE INC
Entity Type:Organization
Organization Name:MANNA HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO, CFO, SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-264-9809
Mailing Address - Street 1:1800 BROADVIEW DR STE 266
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1259
Mailing Address - Country:US
Mailing Address - Phone:747-264-9809
Mailing Address - Fax:747-264-9810
Practice Address - Street 1:1800 BROADVIEW DR STE 266
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1259
Practice Address - Country:US
Practice Address - Phone:747-264-9809
Practice Address - Fax:747-264-9810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based