Basic Information
| Provider Information | |||||||||
| NPI: | 1093054611 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARBOR HOSPICE OF LOS ANGELES, LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4955 VAN NUYS BLVD | ||||||||
| Address2: | SUITE 502 | ||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914031801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2133585090 | ||||||||
| FaxNumber: | 8185281255 | ||||||||
| Practice Location | |||||||||
| Address1: | 3406 COLLEGE ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777014612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4098132332 | ||||||||
| FaxNumber: | 4092320573 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2013 | ||||||||
| LastUpdateDate: | 01/29/2016 | ||||||||
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| AuthorizedOfficialLastName: | THIBODAUX | ||||||||
| AuthorizedOfficialFirstName: | BRAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF DATA OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4098132332 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
No ID Information.