Provider Demographics
NPI:1215349014
Name:DEFINITIVE HOSPICE INC
Entity type:Organization
Organization Name:DEFINITIVE HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:RADENBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-254-2573
Mailing Address - Street 1:1814 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504
Mailing Address - Country:US
Mailing Address - Phone:323-254-2573
Mailing Address - Fax:213-725-9736
Practice Address - Street 1:3310 VERDUGO RD STE B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-2845
Practice Address - Country:US
Practice Address - Phone:323-256-2655
Practice Address - Fax:213-725-9736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based