Provider Demographics
NPI:1427482710
Name:CB HOMECARE HOSPICE CORPORATION
Entity type:Organization
Organization Name:CB HOMECARE HOSPICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CORAZON
Authorized Official - Middle Name:MUGAS
Authorized Official - Last Name:CO
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:818-241-5910
Mailing Address - Street 1:512 E WILSON AVE
Mailing Address - Street 2:SUITE #204
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4351
Mailing Address - Country:US
Mailing Address - Phone:818-241-5910
Mailing Address - Fax:818-241-5912
Practice Address - Street 1:512 E WILSON AVE
Practice Address - Street 2:SUITE #204
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4351
Practice Address - Country:US
Practice Address - Phone:818-241-5910
Practice Address - Fax:818-241-5912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550002000251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550002000Medicaid