Provider Demographics
NPI:1730510819
Name:ESPECIAL CARE HOSPICE, INC.
Entity type:Organization
Organization Name:ESPECIAL CARE HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / DPCS
Authorized Official - Prefix:
Authorized Official - First Name:RIZALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CUSTODIO
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:818-387-6280
Mailing Address - Street 1:6740 VESPER AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4612
Mailing Address - Country:US
Mailing Address - Phone:818-387-6280
Mailing Address - Fax:888-700-5983
Practice Address - Street 1:6740 VESPER AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4612
Practice Address - Country:US
Practice Address - Phone:818-387-6280
Practice Address - Fax:888-700-5983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5550002388251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based