COASTAL HOSPICE OF SOCAL INC NPI 1821636549

NPI Information

NPI: 1821636549
Provider Name: COASTAL HOSPICE OF SOCAL INC
Classification: Hospice Care, Community Based - 251G00000X
Entity Type: Organization

CLIA Number: 05D2210756

Address:
12465 LEWIS ST STE 206
GARDEN GROVE, CA
ZIP 92840
Phone: (951) 310-3338
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COASTAL HOSPICE OF SOCAL INC is a hospice care community based in Garden Grove, CA. COASTAL HOSPICE OF SOCAL INC NPI is 1821636549. The provider is registered as an organization entity type.

The provider's business location address is:

12465 LEWIS ST STE 206
GARDEN GROVE, CA
ZIP 92840-657
Phone: (951) 310-3338

The provider's authorized official is John Patrick Simbulan .
The authorized official title is Owner/administrator and has the following contact phone number (310) 310-3338.

The CLIA number assigned to this NPI record is 05D2210756 - hospice with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/12/2019 and was last updated on 12/12/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	251G00000X	Hospice Care, Community Based				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1417332057	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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