PD Hospice, Inc.

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

PD HOSPICE, INC.

Practice address

10324 Balboa Blvd Ste 200
Granada Hills, CA 91344-7349

Phone

(747) 202-0733

Fax

(323) 366-4357

NPI assigned

Aug 14, 2020

Organization subpart

No

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

Authorized official

Name

Raquel Lacuesta

Title

Ceo/ President

Phone

(747) 202-0733

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Hospice certification: CCN B21688

Legal name

PD HOSPICE INC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Aug 7, 2021

Last certification

Aug 7, 2021

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Jul 1, 2020 in CA

Enrollment address

8700 Reseda Blvd
Ste 218
Northridge, CA 91324-4087

Listed as

PD Hospice IncCCN B21688

Ownership

For-Profit

Certified

Aug 7, 2021

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 6

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.

• Phillip Tafoya, MD

  • Specialist
  • Temecula, CA
  • NPI 1073509469

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1597363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714608000000",
    "number": "1821609660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10324 BALBOA BLVD STE 200",
            "city": "GRANADA HILLS",
            "state": "CA",
            "postal_code": "913447349",
            "telephone_number": "747-202-0733",
            "fax_number": "323-366-4357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10324 BALBOA BLVD STE 200",
            "city": "GRANADA HILLS",
            "state": "CA",
            "postal_code": "913447349",
            "telephone_number": "747-202-0733",
            "fax_number": "323-366-4357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PD HOSPICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-14",
        "last_updated": "2024-05-02",
        "certification_date": "2024-05-02",
        "status": "A",
        "authorized_official_last_name": "LACUESTA",
        "authorized_official_first_name": "RAQUEL",
        "authorized_official_title_or_position": "CEO/ PRESIDENT",
        "authorized_official_telephone_number": "747-202-0733"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "WWW.GMAIL.COM",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "8700 Reseda Blvd Ste 218",
            "city": "Northridge",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913244087",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Community Based Hospice Care Agency in Granada Hills, CA
• Providers in Granada Hills, 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 May 2, 2024; 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.