MEDICARE: LIFE 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	251E00000X	Home Health Agency		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588158893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE HOSPICE, INC.

Provider Business Mailing Address
First Line	:	11033 COHASSET ST
Second Line	:
City	:	SUN VALLEY
State	:	CA
Zip	:	91352-4702
Country	:	US
Telephone Number	:	747-202-8430
Fax Number	:	714-333-4447

Provider Business Practice Location Address
First Line	:	5101 E LA PALMA AVE STE 100P
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92807-2056
Country	:	US
Telephone Number	:	714-464-2018
Fax Number	:	714-333-4447

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	APRINE MELIKYAN
Credential	:
Telephone Number	:	747-202-8430

Provider Enumeration Date	:	06/20/2018
Last Update Date	:	06/20/2018

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