Provider Demographics
NPI:1720688724
Name:ST JAMES HOSPICE, INC
Entity Type:Organization
Organization Name:ST JAMES HOSPICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIONGSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-645-1141
Mailing Address - Street 1:14545 FRIAR ST STE 205
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2398
Mailing Address - Country:US
Mailing Address - Phone:323-645-1141
Mailing Address - Fax:323-645-1142
Practice Address - Street 1:14545 FRIAR ST STE 205
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2398
Practice Address - Country:US
Practice Address - Phone:323-645-1141
Practice Address - Fax:323-645-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based