Provider Demographics
NPI:1982853024
Name:WESTSIDE HOSPICE,INC.
Entity Type:Organization
Organization Name:WESTSIDE HOSPICE,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAIZY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-331-3185
Mailing Address - Street 1:3171 LOS FELIZ BLVD
Mailing Address - Street 2:#313
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-1527
Mailing Address - Country:US
Mailing Address - Phone:323-331-3186
Mailing Address - Fax:
Practice Address - Street 1:3171 LOS FELIZ BLVD
Practice Address - Street 2:#313
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-1527
Practice Address - Country:US
Practice Address - Phone:323-331-3186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1962688374OtherNPI