Provider Demographics
NPI:1336663251
Name:LA VIDA HOSPICE, INC.
Entity type:Organization
Organization Name:LA VIDA HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAMUKOV
Authorized Official - Middle Name:
Authorized Official - Last Name:MURAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-384-8613
Mailing Address - Street 1:732 W 9TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3629
Mailing Address - Country:US
Mailing Address - Phone:424-570-1481
Mailing Address - Fax:424-421-0090
Practice Address - Street 1:732 W 9TH ST STE 202
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3629
Practice Address - Country:US
Practice Address - Phone:424-570-1481
Practice Address - Fax:310-919-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based