Provider Demographics
NPI:1942781604
Name:MEMORIAL HOSPICE CARE, INC.
Entity Type:Organization
Organization Name:MEMORIAL HOSPICE CARE, INC.
Other - Org Name:DYNAMIC HOSPICE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:PARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-464-2050
Mailing Address - Street 1:14260 VENTURA BLVD STE 200B
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2734
Mailing Address - Country:US
Mailing Address - Phone:818-464-2050
Mailing Address - Fax:
Practice Address - Street 1:14260 VENTURA BLVD STE 200B
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2734
Practice Address - Country:US
Practice Address - Phone:818-464-2050
Practice Address - Fax:818-935-6687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1942781604Medicaid