Provider Demographics
NPI:1154720522
Name:ELIM WELLCARE HOSPICE, LLC
Entity type:Organization
Organization Name:ELIM WELLCARE HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-793-7511
Mailing Address - Street 1:690 WILSHIRE PL STE 307
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-3930
Mailing Address - Country:US
Mailing Address - Phone:626-793-7511
Mailing Address - Fax:626-782-6990
Practice Address - Street 1:690 WILSHIRE PL STE 307
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-3930
Practice Address - Country:US
Practice Address - Phone:626-793-7511
Practice Address - Fax:626-782-6990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based