Provider Demographics
NPI:1730163148
Name:PACIFIC HOSPICE CARE CORPORATION
Entity type:Organization
Organization Name:PACIFIC HOSPICE CARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-382-3835
Mailing Address - Street 1:17141 VENTURA BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4038
Mailing Address - Country:US
Mailing Address - Phone:213-382-3825
Mailing Address - Fax:213-386-1664
Practice Address - Street 1:17141 VENTURA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4038
Practice Address - Country:US
Practice Address - Phone:213-382-3825
Practice Address - Fax:213-826-1664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980001560251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01768FMedicaid
8025635Medicare UPIN
CAHPC01768FMedicaid