Provider Demographics
NPI:1982174512
Name:OMEGALIFE HOSPICE OF CALIFORNIA, INC.
Entity Type:Organization
Organization Name:OMEGALIFE HOSPICE OF CALIFORNIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLYDALE
Authorized Official - Middle Name:P
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-357-0398
Mailing Address - Street 1:21151 S WESTERN AVE STE 256
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-1724
Mailing Address - Country:US
Mailing Address - Phone:310-755-2540
Mailing Address - Fax:
Practice Address - Street 1:21151 S WESTERN AVE STE 256
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-1724
Practice Address - Country:US
Practice Address - Phone:310-755-2540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based