Provider Demographics
NPI:1487089579
Name:INNERJOY HOSPICE CARE INCORPORATED
Entity type:Organization
Organization Name:INNERJOY HOSPICE CARE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:MICHAYLUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-359-9447
Mailing Address - Street 1:PO BOX 7610
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91327-7610
Mailing Address - Country:US
Mailing Address - Phone:818-359-9447
Mailing Address - Fax:805-522-1704
Practice Address - Street 1:1965 YOSEMITE AVE STE 115
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-5220
Practice Address - Country:US
Practice Address - Phone:805-522-5010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-07
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA751583Medicare Oscar/Certification