Healthcare Provider Details

I. General information

NPI: 1093324725
Provider Name (Legal Business Name): BUENA VISTA HOSPICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 N SAN FERNANDO BLVD STE 208
BURBANK CA
91502-1238
US

IV. Provider business mailing address

146 N SAN FERNANDO BLVD STE 208
BURBANK CA
91502-1238
US

V. Phone/Fax

Practice location:
  • Phone: 818-736-5555
  • Fax:
Mailing address:
  • Phone: 818-736-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: GREGORY MIKITARIAN
Title or Position: CEO
Credential: RN
Phone: 818-736-5555