Provider Demographics
NPI:1316921760
Name:ST. CLAIR HOSPICE, INC.
Entity type:Organization
Organization Name:ST. CLAIR HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET ROSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LANAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:310-864-2807
Mailing Address - Street 1:8501 WILSHIRE BLVD.
Mailing Address - Street 2:SUITE 336
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3134
Mailing Address - Country:US
Mailing Address - Phone:310-933-6886
Mailing Address - Fax:310-289-5148
Practice Address - Street 1:8501 WILSHIRE BLVD.
Practice Address - Street 2:SUITE 336
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3134
Practice Address - Country:US
Practice Address - Phone:310-933-6886
Practice Address - Fax:310-289-5148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980000962251G00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA051668Medicare ID - Type Unspecified