Eden Hospice Care,Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

EDEN HOSPICE CARE,INC

Practice address

3333 S Brea Canyon Rd Ste 107
Diamond Bar, CA 91765-3782

Phone

(213) 596-9119

Fax

(213) 596-9153

NPI assigned

Jun 7, 2012

Organization subpart

No

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

Authorized official

Name

David Kyu Ko

Title

Administrator / Ceo

Phone

(213) 596-9119

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Hospice certification: CCN 751575

Legal name

EDEN HOSPICE CARE,INC.

Certification status

Active

Provider type (POS)

Hospice

Participating since

Jul 29, 2014

Last certification

May 27, 2021

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Enrollment address

1818 S. Western Ave.,
Ste 200-a
Los Angeles, CA 90006-5862

Listed as

Eden Hospice Care IncCCN 751575 · All quality measures

Ownership

For-Profit

Certified

Jul 29, 2014

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.

• Robert A Tracy, DO

  • Adult Medicine Physician
  • Los Angeles, CA
  • NPI 1316219058

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1339027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507680000000",
    "number": "1942562798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 S BREA CANYON RD STE 107",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917653782",
            "telephone_number": "213-596-9119",
            "fax_number": "213-596-9153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 S BREA CANYON RD STE 107",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917653782",
            "telephone_number": "213-596-9119",
            "fax_number": "213-596-9153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDEN HOSPICE CARE,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-07",
        "last_updated": "2017-10-11",
        "status": "A",
        "authorized_official_last_name": "KO",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "KYU",
        "authorized_official_title_or_position": "ADMINISTRATOR / CEO",
        "authorized_official_telephone_number": "213-596-9119"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community Based Hospice Care Agency in Diamond Bar, CA
• Providers in Diamond Bar, 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 Oct 11, 2017; 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.