NPIMap

Organization Active NPI

Miracle Mile Hospice Care, Inc.

  • Community Based Hospice Care Agency
  • Los Angeles, CA
National Provider Identifier
1801221049
Registry record updated Apr 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
MIRACLE MILE HOSPICE CARE, INC.
Practice address
5670 Wilshire Blvd
Suite 1600a
Los Angeles, CA 90036
Phone
(323) 951-0880
Fax
(323) 951-0890
NPI assigned
Sep 6, 2013
Last updated
Apr 18, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2018

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

Authorized official

Name
Mr. Felix Francisco De Guzman, RN
Title
Administrator
Phone
(323) 951-0880

Specialties & licenses 1

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

Addresses

Primary practice location

5670 Wilshire Blvd
Suite 1600a
Los Angeles, CA 90036

Mailing address

5670 Wilshire Blvd
Suite 1600a
Los Angeles, CA 90036
Phone (323) 951-0880

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140326002336 CA Part A Provider - Hospice 3476784992 Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801221049. Details of each certification follow.

Hospice certification: CCN 751760

Legal name
MIRACLE MILE HOSPICE CARE, INC.
Certification status
Active
Provider type (POS)
Hospice
Participating since
Dec 7, 2015
Last certification
Nov 8, 2018
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Jul 31, 2013 in CA
Enrollment address
5670 Wilshire Blvd
Ste 1600a
Los Angeles, CA 90036-5679

Care Compare: Hospice

Medicare Care Compare
Listed as
Miracle Mile Hospice Care, IncCCN 751760 · All quality measures
Ownership
For-Profit
Certified
Dec 7, 2015
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

6399 Wilshire Blvd
Ste 809
Los Angeles, CA 90048
Phone (323) 951-0880

Ownership & related parties

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.

NameRoleSinceShare
Hazel P Aro Individual 5% Or Greater Direct Ownership Interest Jul 31, 2013 50%
Corporate OfficerVice-President/Secretary Aug 12, 2013 50%
Corporate DirectorDirector of Patient Care Service Aug 12, 2013 50%
Operational/Managerial ControlDirector of Patient Care Service Aug 12, 2013 50%
Felix F de Guzman Individual 5% Or Greater Direct Ownership Interest Jul 31, 2013 50%
Corporate OfficerCeo/President Aug 12, 2013 50%
Operational/Managerial ControlAdministrator Aug 12, 2013 50%

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": "1378425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524009600000",
    "number": "1801221049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5670 WILSHIRE BLVD",
            "address_2": "SUITE 1600A",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90036",
            "telephone_number": "323-951-0880",
            "fax_number": "323-951-0890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5670 WILSHIRE BLVD",
            "address_2": "SUITE 1600A",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90036",
            "telephone_number": "323-951-0880",
            "fax_number": "323-951-0890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRACLE MILE HOSPICE CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-06",
        "last_updated": "2018-04-18",
        "status": "A",
        "authorized_official_last_name": "DE GUZMAN",
        "authorized_official_first_name": "FELIX",
        "authorized_official_middle_name": "FRANCISCO",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "323-951-0880",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.