Provider Demographics
NPI:1649840844
Name:ARCHANGEL LIGHT HOSPICE
Entity type:Organization
Organization Name:ARCHANGEL LIGHT HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-344-9198
Mailing Address - Street 1:2775 TAPO ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-0467
Mailing Address - Country:US
Mailing Address - Phone:818-388-7082
Mailing Address - Fax:818-514-2068
Practice Address - Street 1:2775 TAPO ST STE 202
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-0467
Practice Address - Country:US
Practice Address - Phone:818-388-7082
Practice Address - Fax:818-514-2068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based