Provider Demographics
NPI:1265063978
Name:GOLDEN STATE HOSPICE
Entity type:Organization
Organization Name:GOLDEN STATE HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RUPA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-678-9835
Mailing Address - Street 1:20945 DEVONSHIRE ST STE 206
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-2370
Mailing Address - Country:US
Mailing Address - Phone:818-678-9835
Mailing Address - Fax:818-812-9477
Practice Address - Street 1:20945 DEVONSHIRE ST STE 206
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-2370
Practice Address - Country:US
Practice Address - Phone:818-678-9835
Practice Address - Fax:818-812-9477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-31
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265063978Medicaid