Provider Demographics
NPI:1720661382
Name:MEDI HOSPICE CARE INC
Entity Type:Organization
Organization Name:MEDI HOSPICE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-744-5012
Mailing Address - Street 1:17337 VENTURA BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3978
Mailing Address - Country:US
Mailing Address - Phone:747-744-5012
Mailing Address - Fax:747-744-5013
Practice Address - Street 1:17337 VENTURA BLVD STE 106
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3978
Practice Address - Country:US
Practice Address - Phone:747-744-5012
Practice Address - Fax:747-744-5013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-02
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based