MEDICARE: KIND HEARTS 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

General Provider Information

NPI Number	:	1407461643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIND HEARTS HOSPICE, INC.

Provider Business Mailing Address
First Line	:	10210 N 32ND ST STE 215
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-3848
Country	:	US
Telephone Number	:	602-953-4875
Fax Number	:	480-573-8595

Provider Business Practice Location Address
First Line	:	10210 N 32ND ST STE 215
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-3848
Country	:	US
Telephone Number	:	602-953-4875
Fax Number	:	480-573-8595

Authorized Official
Title or Position	:	CEO/ADMINISTRATOR
Name	:	KHACHATUR ZADIKYAN
Credential	:
Telephone Number	:	818-689-7164

Provider Enumeration Date	:	09/14/2020
Last Update Date	:	09/14/2020

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