Provider Demographics
NPI:1962043745
Name:SHRINE HOSPICE CARE, INC
Entity Type:Organization
Organization Name:SHRINE HOSPICE CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NUSSBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-774-9996
Mailing Address - Street 1:7120 HAYVENHURST AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3813
Mailing Address - Country:US
Mailing Address - Phone:818-446-9798
Mailing Address - Fax:
Practice Address - Street 1:7120 HAYVENHURST AVE STE 212
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3813
Practice Address - Country:US
Practice Address - Phone:818-446-9798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1962043745Medicaid