NPIMap

Organization Active NPI

Angel Care Hospice LLC.

  • Community Based Hospice Care Agency
  • Burbank, CA
National Provider Identifier
1346882610
Registry record updated Dec 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
ANGEL CARE HOSPICE LLC.
Practice address
4100 W Alameda Ave Ste 385
Burbank, CA 91505-4195
Phone
(747) 200-5470
Fax
(747) 200-1927
NPI assigned
Oct 8, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2022

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

Authorized official

Name
Jennifer Valdes
Title
Ceo
Phone
(747) 200-5470

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

4100 W Alameda Ave Ste 385
Burbank, CA 91505-4195

Mailing address

4100 W Alameda Ave Ste 385
Burbank, CA 91505-4195
Phone (747) 200-5470

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221214001326 CA Part A Provider - Hospice 7719398916 Practice locations: Burbank, CA

Hospice certification: CCN B51785

Legal name
ANGEL CARE HOSPICE LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jul 31, 2023
Last certification
Jun 22, 2023
Organization structure
LLCProprietary
Incorporated
Sep 11, 2019 in CA
Enrollment address
4100 W Alameda Ave
Ste 385
Burbank, CA 91505-4195

Care Compare: Hospice

Medicare Care Compare
Listed as
Angel Care Hospice, LLCCCN B51785 · All quality measures
Certified
Jul 31, 2023
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

4100 W Alameda Ave
Ste 385
Burbank, CA 91505
Phone (747) 200-5470

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Gary a Grimes Individual Contracted Managing EmployeeMD; Oct 10, 2023 100%
Eva Lyn Johnson Individual W-2 Managing EmployeeAdministrator Designee/DPCS Designe Oct 1, 2025 50%
Valarie Renaux Individual W-2 Managing EmployeeAd;DPCS Oct 1, 2024 50%
Jennifer Valdes Individual 5% Or Greater Direct Ownership InterestCeo/Cfo/Board Member Dec 8, 2022 50%
Corporate OfficerCeo/Cfo/Board Member Dec 8, 2022 50%
Corporate DirectorCeo/Cfo/Board Member Dec 8, 2022 50%
W-2 Managing EmployeeCeo/Cfo/Board Member Dec 8, 2022 50%
Yanira Valle Individual 5% Or Greater Direct Ownership InterestSecretary/Board Member Dec 8, 2022 50%
Corporate OfficerSecretary/Board Member Dec 8, 2022 50%
Corporate DirectorSecretary/Board Member Dec 8, 2022 50%
W-2 Managing EmployeeSecretary/Board Member Dec 8, 2022 50%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 1

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

NPI Registry JSON

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

{
    "created_epoch": "1570492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670371200000",
    "number": "1346882610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 W ALAMEDA AVE STE 385",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915054195",
            "telephone_number": "747-200-5470",
            "fax_number": "747-200-1927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 W ALAMEDA AVE STE 385",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915054195",
            "telephone_number": "747-200-5470",
            "fax_number": "747-200-1927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGEL CARE HOSPICE LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-08",
        "last_updated": "2022-12-07",
        "certification_date": "2022-12-07",
        "status": "A",
        "authorized_official_last_name": "VALDES",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "747-200-5470"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burbank, CA

Sources for this page

Verify at the official NPI Registry.