MEDICARE: LIFE ROOTS HOSPICE CARE, 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

General Provider Information

NPI Number	:	1386237725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE ROOTS HOSPICE CARE, INC

Provider Business Mailing Address
First Line	:	6410 VAN NUYS BLVD STE F203
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-6263
Country	:	US
Telephone Number	:	747-666-0642
Fax Number	:

Provider Business Practice Location Address
First Line	:	6410 VAN NUYS BLVD STE F203
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-6263
Country	:	US
Telephone Number	:	747-666-0642
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ASHKHEN ATOYAN
Credential	:
Telephone Number	:	747-666-0642

Provider Enumeration Date	:	02/17/2021
Last Update Date	:	10/26/2022

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