MEDICARE: V & G 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	:	1548813058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	V & G HOSPICE INC

Provider Business Mailing Address
First Line	:	14545 FRIAR ST STE 105
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91411-2357
Country	:	US
Telephone Number	:	747-247-3320
Fax Number	:	747-247-3321

Provider Business Practice Location Address
First Line	:	14545 FRIAR ST STE 105
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91411-2357
Country	:	US
Telephone Number	:	747-247-3320
Fax Number	:	747-247-3321

Authorized Official
Title or Position	:	CEO
Name	:	ANAHIT YESAYAN
Credential	:
Telephone Number	:	747-247-3320

Provider Enumeration Date	:	07/23/2019
Last Update Date	:	07/23/2019

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