Amazon Hospice Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

AMAZON HOSPICE INC

Doing business as

Bridgewater Hospice

Practice address

2420 W Carson St Ste 205
Torrance, CA 90501-3157

Phone

(310) 320-0443

NPI assigned

Jun 6, 2016

Last updated

Jun 6, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Adeoye Moses Ogunlade, CEO

Title

President

Phone

(310) 320-0443

Specialties & licenses 1

Addresses

Other names 1

• Bridgewater Hospice Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063861540. Details of each certification follow.

• CCN A01745 Hospice · Active · Details

Hospice certification: CCN A01745

Legal name

AMAZON HOSPICE, INC.

Doing business as

BRIDGEWATER HOSPICE

Certification status

Active

Provider type (POS)

Hospice

Participating since

Jan 3, 2020

Last certification

Jan 3, 2020

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Sep 14, 2014 in CA

Enrollment address

2420 W Carson St
Ste 205
Torrance, CA 90501-3157

Listed as

Bridgewater HospiceCCN A01745 · All quality measures

Ownership

For-Profit

Certified

Jan 3, 2020

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Martin Zapata, D.O

  • Internal Medicine Physician
  • Norwalk, CA
  • NPI 1689628240

  Hospice

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465171200000",
    "number": "1063861540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2420 W CARSON ST STE 205",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905013157",
            "telephone_number": "310-320-0443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2420 W CARSON ST STE 205",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905013157",
            "telephone_number": "310-320-0443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMAZON HOSPICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-06",
        "last_updated": "2016-06-06",
        "status": "A",
        "authorized_official_last_name": "OGUNLADE",
        "authorized_official_first_name": "ADEOYE",
        "authorized_official_middle_name": "MOSES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-320-0443",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bridgewater Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community Based Hospice Care Agency in Torrance, CA
• Providers in Torrance, CA by specialty
• Community Based Hospice Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.