Provider Demographics
NPI:1396319091
Name:KAIESAM HOSPICE LLC
Entity type:Organization
Organization Name:KAIESAM HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:AVILIO
Authorized Official - Last Name:CASTILLO VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-404-5815
Mailing Address - Street 1:9660 FLAIR DR STE 208
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-3007
Mailing Address - Country:US
Mailing Address - Phone:626-522-1104
Mailing Address - Fax:626-522-0149
Practice Address - Street 1:9660 FLAIR DR STE 208
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-3007
Practice Address - Country:US
Practice Address - Phone:626-522-1104
Practice Address - Fax:626-522-0149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based