MEDICARE: AMAG HOSPICE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency		CA

General Provider Information

NPI Number	:	1013467265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMAG HOSPICE, INC.

Provider Business Mailing Address
First Line	:	1736 ERRINGER RD
Second Line	:	SUITE 106
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-3558
Country	:	US
Telephone Number	:	818-934-7755
Fax Number	:	888-512-1287

Provider Business Practice Location Address
First Line	:	1736 ERRINGER RD
Second Line	:	SUITE 106
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-3558
Country	:	US
Telephone Number	:	818-934-7755
Fax Number	:	888-512-1287

Authorized Official
Title or Position	:	CEO
Name	:	MR. HAROUT DZHIMBASHYAN
Credential	:
Telephone Number	:	818-934-7755

Provider Enumeration Date	:	10/12/2016
Last Update Date	:	10/12/2016

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