Provider Demographics
NPI:1962667600
Name:SACRED HEART HOSPICE, INC.
Entity Type:Organization
Organization Name:SACRED HEART HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:G
Authorized Official - Last Name:CORDERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-385-4247
Mailing Address - Street 1:3731 WILSHIRE BLVD STE 618
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2876
Mailing Address - Country:US
Mailing Address - Phone:213-385-4247
Mailing Address - Fax:213-385-4238
Practice Address - Street 1:3731 WILSHIRE BLVD STE 618
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2876
Practice Address - Country:US
Practice Address - Phone:213-385-4247
Practice Address - Fax:213-385-4238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000246251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55-1528Medicare PIN