Provider Demographics
NPI:1649537150
Name:PROMISE HOSPICE, INC.
Entity type:Organization
Organization Name:PROMISE HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ZULFICAR
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:RESTUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-205-2587
Mailing Address - Street 1:2140 W. OLYMPIC BLVD
Mailing Address - Street 2:SUITE 326
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2279
Mailing Address - Country:US
Mailing Address - Phone:310-205-2587
Mailing Address - Fax:310-362-8805
Practice Address - Street 1:2140 W. OLYMPIC BLVD
Practice Address - Street 2:SUITE 326
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2279
Practice Address - Country:US
Practice Address - Phone:310-205-2587
Practice Address - Fax:310-362-8805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based