Provider Demographics
NPI:1205810769
Name:PASADENA HOSPICES, INC.
Entity type:Organization
Organization Name:PASADENA HOSPICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BSN
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CANALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-398-0195
Mailing Address - Street 1:408 S ROSEMEAD BLVD #5
Mailing Address - Street 2:STE 5
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-4931
Mailing Address - Country:US
Mailing Address - Phone:626-398-0195
Mailing Address - Fax:626-398-0113
Practice Address - Street 1:408 S ROSEMEAD BLVD #5
Practice Address - Street 2:STE 5
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4931
Practice Address - Country:US
Practice Address - Phone:626-398-0195
Practice Address - Fax:626-398-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251G00000X251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPCO1782FMedicaid
CAHPCO1782FMedicaid