Basic Information
| Provider Information | |||||||||
| NPI: | 1467881490 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LONG BEACH HOSPICE CARE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 ROOSEVELT RD | ||||||||
| Address2: | SUITE C206 | ||||||||
| City: | GLEN ELLYN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601375839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309420100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3646 LONG BEACH BLVD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908074014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629895300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2013 | ||||||||
| LastUpdateDate: | 11/12/2013 | ||||||||
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| AuthorizedOfficialLastName: | THOME | ||||||||
| AuthorizedOfficialFirstName: | GREG | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6309420100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 550002349 | CA | Y | Agencies | Hospice Care, Community Based |
No ID Information.