Provider Demographics
NPI:1285243386
Name:PROFESSIONAL LIFECARE HOSPICE, INC.
Entity type:Organization
Organization Name:PROFESSIONAL LIFECARE HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES CONRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRATITIONER
Authorized Official - Phone:818-818-6509
Mailing Address - Street 1:8363 RESEDA BLVD UNIT 200B
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4623
Mailing Address - Country:US
Mailing Address - Phone:818-818-6509
Mailing Address - Fax:888-315-8448
Practice Address - Street 1:8363 RESEDA BLVD UNIT 200B
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4623
Practice Address - Country:US
Practice Address - Phone:818-818-6509
Practice Address - Fax:888-315-8448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE3594539OtherDRIVERS LICENSE