MEDICARE: EMINENT 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	:	1992134696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMINENT HOSPICE CARE, INC.

Provider Business Mailing Address
First Line	:	13758 VICTORY BLVD
Second Line	:	SUITE 207
City	:	VAN NUYS
State	:	CA
Zip	:	91401-2319
Country	:	US
Telephone Number	:	818-442-9700
Fax Number	:	818-442-9701

Provider Business Practice Location Address
First Line	:	13758 VICTORY BLVD
Second Line	:	SUITE 207
City	:	VAN NUYS
State	:	CA
Zip	:	91401-2319
Country	:	US
Telephone Number	:	818-442-9700
Fax Number	:	818-442-9701

Authorized Official
Title or Position	:	CEO
Name	:	GAYANE KIRAKOSYAN
Credential	:
Telephone Number	:	818-442-9700

Provider Enumeration Date	:	11/04/2013
Last Update Date	:	11/04/2013

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