Healthcare Provider Details

I. General information

NPI: 1427325802
Provider Name (Legal Business Name): PRO HOSPICE AGENCY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2011
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 W SHAW AVE SUITE 106
FRESNO CA
93711-3508
US

IV. Provider business mailing address

1665 W SHAW AVE SUITE 106
FRESNO CA
93711-3508
US

V. Phone/Fax

Practice location:
  • Phone: 559-435-9991
  • Fax:
Mailing address:
  • Phone: 559-435-9991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number550002572
License Number StateCA

VIII. Authorized Official

Name: RIPSIME DANIELYAN
Title or Position: CEO
Credential:
Phone: 559-435-9991